The ACA enhanced premium tax credits expired on January 1, 2026. The consequences for millions of Americans' healthcare access are now fully documented — and the numbers are more severe than most enrollees understood when they made their plan choices.
According to a KFF analysis published May 19, 2026, the average Affordable Care Act Marketplace deductible grew by 37% — or more than $1,000 per person — from $2,759 in 2025 to $3,786 in 2026. This is the steepest single-year deductible increase in the ACA Marketplace's history. It occurred not because plans themselves became dramatically less generous, but because millions of enrollees were priced out of more comprehensive coverage and shifted to cheaper, higher-deductible bronze plans.
For many of these enrollees, having insurance does not mean having usable insurance. A deductible of $3,786 means a person must pay $3,786 out of pocket before most of their coverage kicks in — for hospitalizations, specialist visits, diagnostic tests, and treatment — every year.
What Actually Happened — The Bronze Plan Migration and Its Consequences
When the enhanced premium tax credits expired, the cost of maintaining the same silver or gold plan increased dramatically for many enrollees. KFF estimated the average increase in premium payments was 114% for subsidized enrollees keeping the same plan, an average jump from $888 to $1,904 per year. The practical response for millions of people was rational, if financially precarious: switch to a lower-cost bronze plan to reduce monthly premiums.
According to KFF's main analysis, the consequences of this shift are stark:
- Bronze plan share jumped from 30% (7.3 million people) in 2025 to 40% (9.2 million people) in 2026
- Silver plan share fell from 57% (13.7 million) to 43% (9.8 million) — a record low and the first time fewer than half of ACA consumers have selected a silver plan
- The average monthly premium payment rose from $113 to $178, a 58% increase, though lower than the projected 114% because many consumers downgraded coverage
- ACA plan sign-ups fell by more than 1 million — from 24+ million in 2025 to 23.1 million during Open Enrollment 2026 — the sharpest single-year decline since the ACA Marketplaces launched
The Peterson-KFF Health System Tracker explains the specific mechanics: in 2026, the average deductible for a silver plan is $5,304 and for a bronze plan is $7,186. Cost-sharing reductions (CSRs), which dramatically lower deductibles for lower-income silver plan enrollees, are not available on bronze plans. This means a lower-income person who switched from a silver plan (with CSR, potentially a $80 deductible) to a bronze plan (no CSR, $7,476 average deductible) to save on premiums may have saved $100 per month on premiums while increasing their annual deductible by $7,000 — a catastrophic trade-off that is invisible until they actually need medical care.
| ACA Marketplace 2026 — Key Data | 2025 | 2026 | Change |
| Average Marketplace deductible | $2,759 | $3,786 | +37% (+$1,027) |
| Bronze plan share of enrollment | 30% (7.3M) | 40% (9.2M) | +10 percentage points |
| Silver plan share of enrollment | 57% (13.7M) | 43% (9.8M) | −14 percentage points (record low) |
| Average monthly premium (net of credits) | $113 | $178 | +58% |
| Total sign-ups (Open Enrollment) | 24.1M | 23.1M | −1M (record annual decline) |
| Projected effectuated enrollment 2026 | 22.3M | ~17.5M | −21.5% |
| Enrollees saying health costs "a lot higher" | — | 51% | KFF survey |
| Enrollees who would cut household spending if costs ↑$1,000 | 67% | — | KFF pre-expiration survey |
Who Got Hurt Most — and Where the Coverage Losses Are Concentrated
The coverage impact is not evenly distributed. According to KFF's enrollment analysis, the "subsidy cliff" that the enhanced credits had eliminated returned in full force: households with incomes above 400% of the federal poverty level (approximately $62,600 for a single person in 2026) lost all subsidy eligibility and faced the full unsubsidized premium. This group made up just 7% of 2025 Marketplace enrollment but accounted for nearly 48% of the decline in plan selections from 2025 to 2026.
Middle-income adults — earning too much for Medicaid, too much for the largest subsidies, but not enough to comfortably absorb full-cost premiums — were disproportionately affected. Plan sign-ups declined in 41 states, with the largest percentage drops in North Carolina (22%), Ohio (20%), West Virginia (17%), Indiana, Delaware, and Arizona (all 16%).
A KFF follow-up survey published March 19, 2026 found that among those who re-enrolled, 80% said their plan's premiums, deductibles, or cost-sharing were higher than the previous year, including 51% who said costs were "a lot higher." In their own words, one enrollee described their situation: "Income exceeded the subsidy limit, forcing us to pay the full cost, so we switched down to a bronze from a gold plan. Even doing that our premiums are 3 times what they were in 2025, with lower plan features and a higher deductible."
What a $3,786 Deductible Actually Means for Healthcare Use
The deductible is not an abstract number. It is the amount a patient pays for medical services before insurance begins covering most costs. For a person with a $3,786 deductible who develops a new health problem — who needs a specialist referral, an MRI, a biopsy, or a hospitalization — the first $3,786 of those costs comes entirely from their own pocket.
Research consistently shows that high deductibles cause patients to delay or forgo care. This is not simply a financial preference — it is a documented pattern with clinical consequences. People with high-deductible plans delay cancer screenings, skip follow-up care for chronic conditions like hypertension and diabetes, avoid filling prescriptions for maintenance medications, and present to emergency rooms with more advanced conditions than they would have had they sought earlier care.
According to Commonwealth Fund analysis of emerging state data from June 8, 2026, plan cancellations across reporting state marketplaces rose 24% between January and March of 2026 compared to 2025. In California, Black consumers were canceling coverage at double last year's rate. Middle-income consumers who lost financial assistance were canceling at twice the 2025 rate. The enrollment erosion is not stabilizing — it is accelerating.
Frequently Asked Questions
How much did ACA deductibles increase in 2026?
The average ACA Marketplace deductible grew 37%, from $2,759 in 2025 to $3,786 in 2026 — an increase of more than $1,000 per person and the steepest single-year deductible increase in the ACA Marketplace's history, per KFF analysis published May 19, 2026.
Why did deductibles increase so much?
When the ACA's enhanced premium tax credits expired on January 1, 2026, monthly premiums increased sharply for many enrollees. To offset higher premiums, millions of consumers switched from more comprehensive silver plans (lower deductibles, cost-sharing reductions) to lower-premium bronze plans (higher deductibles, no cost-sharing reductions). This shift drove average deductibles higher even without changes to the plans themselves.
Who was most affected?
Middle-income adults with incomes above 400% of the federal poverty level ($62,600 for a single person in 2026) — who lost all subsidy eligibility when enhanced credits expired — accounted for nearly 48% of coverage declines despite being only 7% of prior enrollment. They faced the starkest choice: pay dramatically higher unsubsidized premiums or go without coverage.
How does a high deductible affect my actual healthcare access?
A high deductible means you pay the first $3,786 (on average) in medical expenses out of pocket before insurance covers most costs. Research consistently shows high-deductible plans cause patients to delay screenings, skip prescriptions, avoid specialist visits, and forgo preventive care — often leading to worse health outcomes and more expensive care when problems are eventually treated.
Did ACA enrollment fall in 2026?
Yes. Plan sign-ups fell by more than 1 million during the 2026 Open Enrollment Period — the sharpest single-year decline since the ACA launched. KFF projects that effectuated enrollment could fall 21.5%, from 22.3 million in 2025 to approximately 17.5 million in 2026.
