ACA Marketplace Enrollment Fell in 2026: What New District Data Means in NC

Photo by Kampus Production on Pexels. Stock photograph; the people shown are models.

What the new marketplace numbers show

ACA Marketplace enrollment fell nationally in 2026 for the first time in seven years. KFF's analysis, published October 8, 2026, reports that effectuated enrollment dropped from 21.8 million people in 2025 to 19.2 million in February 2026, a 12% decline, and KFF expects further decline through the rest of the year. The drop followed the expiration of enhanced premium tax credits at the end of 2025.

Costs rose for the people who stayed enrolled. KFF reports that premium payments among remaining enrollees rose 58% on average and deductibles climbed 37%, about $1,000 per person. In a KFF survey of 2025 enrollees, 1 in 10 said they had become uninsured in early 2026.

Why your congressional district matters

The national figure hides a wide range. KFF estimates enrollment by congressional district, from about 2,000 people in the smallest to 249,000 in the largest. Twenty-eight districts have more than 100,000 Marketplace enrollees — 12 held by Democrats and 16 held by Republicans — and all of them sit in Florida, Texas or Georgia.

The decline was uneven too. Republican-held districts hold 55% of current enrollees but accounted for 67% of the drop between 2025 and 2026. KFF notes that Marketplace enrollment tends to be highest in the South and lower in states with broader public coverage options, such as expanded Medicaid or Basic Health Plans.

What this means for North Carolina

KFF publishes an enrollment estimate for every congressional district, and North Carolina's are included, so you can look up the figure where you live. Two cautions: estimates are rounded to the nearest thousand, and North Carolina is one of nine states that recently redrew district lines, so KFF used a different method to allocate county population there. Read the numbers as scale, not a precise count.

A district estimate cannot tell you whether your doctor stays in network or whether your prescriptions are covered. What matters for your household is the plan itself: the network, the drug list, the deductible and the total you would pay over a year.

Enrollment dates for 2027 coverage

Open Enrollment for 2027 coverage starts November 1, 2026, and runs through January 15, 2027. You can enroll, renew or change plans during that window.

• November 1, 2026: Open Enrollment begins — the first day to enroll in, renew or change a Marketplace plan for 2027.
• December 15, 2026: last day to enroll or change plans for coverage that starts January 1, 2027.
• January 1, 2027: coverage starts for people who enrolled by December 15 and paid the first premium.
• January 15, 2027: Open Enrollment ends. After that, you can enroll or change plans only if you qualify for a Special Enrollment Period.
• February 1, 2027: coverage starts for people who enroll December 16 through January 15 and pay the first premium.

Outside Open Enrollment, certain life events may qualify you for a Special Enrollment Period — for example moving, losing other coverage, getting married or having a baby. The Marketplace usually asks for documents, and the window closes quickly.

Whether premium tax credits apply to you depends on your income, household and other eligibility rules. There is no guarantee of savings, so the honest answer is to run your own numbers through the application rather than assume.

We help you check plans against your doctors, prescriptions and benefits before you decide, and ZAVIA does not charge customers an additional fee for Marketplace enrollment assistance. If you would like to work through your 2027 options, contact us.

Frequently asked questions