The news: 9% of 2025 ACA marketplace enrollees now say they are uninsured, while 50% have either switched marketplace plans or obtained coverage elsewhere, per a KFF poll conducted earlier this month of 1,117 US adults who had marketplace insurance last year. For context, ACA healthcare tax credits that provided financial assistance to about 90% of marketplace enrollees expired at the end of 2025.

Digging into the details: Among 2025 marketplace enrollees who were surveyed:

• 39% have the same plan.
• 28% switched to another ACA marketplace plan.
• 22% switched to another type of insurance coverage, such as Medicaid (7%), from their employer (5%), or Medicare (4%).
• 9% currently don’t have any health insurance.

Younger enrollees dropped out of ACA plans at a higher rate than older people.

• 49% between the ages of 18 and 29 said they’ve left the marketplace entirely, including 14% who say they are currently uninsured.
• That compares with 24% ages 50 and up who have left the marketplace and 7% in that age cohort who are now uninsured,

Why it matters: KFF’s findings provide one of the first detailed looks at the early effects of the ACA tax credit expiration.

As federal subsidies vanish, returning marketplace enrollees are being forced into a precarious balancing act between maintaining coverage and meeting basic cost-of-living needs.

• 63% said their monthly insurance premium is either much higher (40%) or somewhat higher (23%).
• Just 27% said they’re very confident they’ll be able to afford their monthly health insurance premiums for the entire year, while 4% admit they haven’t paid their first premium yet. For context, returning enrollees who received tax credits last year typically have a three-month grace period to pay their first 2026 premium before coverage is terminated.
• Returning enrollees also note that their healthcare costs have made it harder to afford other expenses, including groceries (37%), monthly utilities (32%), and rent or mortgage (30%).
• 43% say they have already or are planning to find an extra job or work more hours to cover rising health expenses.

Implications for health insurers and their marketers: As younger, healthier individuals exit the ACA marketplace to avoid rising premiums, insurance companies’ enrollment mix will shift toward older, high-cost members.

The trickle-down effect could pressure insurer margins: losing out on younger members’ premiums means health plans' remaining premium revenues could be insufficient. These remaining revenues will not be enough to offset the costs of older, sicker members who require more frequent services. This fundamental instability is a big reason why CVS Health/Aetna has exited the ACA marketplace.

Insurers still in the ACA market must equip members with tools and resources to reduce avoidable, high-cost care, especially as monthly premiums surge. This includes doubling down on preventive screenings, covering telehealth for chronic patients who need frequent check-ins, and educating members on finding low-cost services through insurer portals.

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