Dive Brief:
- The average deductible for an Affordable Care Act plan has reached a record high after jumping more than $1,000 between 2025 and 2026 — the largest single-year increase in history, according to a new analysis from health policy research firm KFF.
- The spike is the result of hundreds of thousands more Americans shifting into cheaper, high-deductible bronze plans after more generous subsidies expired and sent the cost of coverage soaring.
- The KFF analysis released Tuesday also estimates that marketplace enrollment could ultimately fall by 5 million people, or 21.5%, this year as more Americans fail to pay their premiums.
Dive Insight:
The ACA exchanges are experiencing historic turbulence after the Republican-led Congress elected to allow enhanced subsidies to lapse at the end of last year. Premiums doubled, on average, as a result, causing more than 1 million Americans to flee the exchanges — the largest year-to-year enrollment drop since the marketplaces were founded more than a decade ago.
Initial enrollment losses weren’t as drastic as some experts feared. But the attrition is expected to continue for the remainder of the year as beneficiaries stop paying their premiums and are booted from coverage.
Last month, health consultancy Wakely estimated that enrollment in the individual market could drop by 17% to 26% this year. KFF analyzed Wakely’s report along with federal data to arrive at its own estimate of a 21.5% decline.
ACA enrollment could fall to about 17.5 million people this year
As the marketplace shrinks, many of the people remaining are shifting into lower premium, higher deductible plans. Between 2025 and 2026, enrollment in bronze plans jumped from 30% of total plan selections to 40%, swelling from 7.3 million people to 9.2 million people, according to the KFF report.
Meanwhile, silver plans, which have higher premiums but lower cost-sharing, fell from 57% of overall enrollment to a record low of 43%, declining from 13.7 million people to 9.8 million people, the KFF found. That shift drove a sharp increase in the average ACA deductible, or the amount that a consumer needs to pay out of pocket before their insurance kicks in.
The average deductible jumped from $2,759 in 2025 to $3,786 in 2026, a record increase of $1,027, according to the KFF report.
Growth in high-deductible coverage is concerning, experts say. The plans are inherently risky. Since they require enrollees to shell out thousands of dollars of their own money before coverage begins, that can lead to people putting off care, being saddled with medical debt or being forced to cut costs in other areas.
The enrollment trends are also worrying for the long-term future of the ACA marketplaces, according to health policy experts. Younger and healthier individuals appear to be exiting the exchanges at a higher rate, leaving those who are remaining sicker and more expensive for insurers to cover. Insurers could jack up premiums further as a result, leading more healthy individuals to eschew coverage and potentially throwing the ACA into an insurance market "death spiral."
The KFF analysis comes as Republicans in Washington have attempted to downplay the impact of the subsidy expiration on ACA enrollees. Health officials have argued that enrollment losses are due to efforts by the Trump administration to tamp down improper or fraudulent ACA sign-ups.
Still, as the public clamors for solutions to make healthcare cheaper and easier to access Republicans have stumped for reform that experts say could drive more individuals into cheaper, but riskier, high-deductible plans.
That includes funneling subsidies into tax-advantaged savings accounts linked to bronze plans and allowing more consumers to sign up for high-deductible catastrophic coverage.
