ACA Marketplace enrollment hits record-high 24.3M enrollees

ACA Marketplace enrollment soars

The KFF analysis showed that ACA Marketplace enrollment has soared to its greatest heights for the 2025 plan year, rising from 21.4 million enrollees in 2024 to 24.3 million for this year.

Those numbers dwarf marketplace enrollments from a decade ago. In 2014, ACA Marketplace enrollment was 8 million people. That figure shot up to 11.7 million people in 2015, where it hovered until 2022, likely the result of ARPA's enhanced subsidies.

Those enhanced subsidies made ACA Marketplace coverage more affordable by providing financial assistance to enrollees making above 400% of the federal poverty line. Without the subsidies, KFF estimated that annual premium payments for subsidized enrollees would have been $705 (79%) higher. That's a difference of $888 with subsidized premiums and $1,593 without.

The future of those enhanced subsidies is uncertain, as they are set to expire at the end of the year without Congressional intervention.

Should Congress not vote to extend the subsidies, the Congressional Budget Office (CBO) estimated that around 3.8 million more people would become uninsured, KFF said. However, there would likely be other downstream effects. Without the enhanced subsidies, the CBO said healthy enrollees might leave the marketplace, creating a sicker beneficiary pool and likely prompting health plans to increase the price of premiums.

Conversely, should Congress vote to extend the subsidies, it could come with a price tag of $335 billion over ten years, per the CBO.

Nearly every state saw enrollment jumps

The increase in ACA Marketplace enrollment was evident in nearly every state save for New York (down 19%), Oregon (4%) and the District of Columbia (down 3%). This is likely because these states have expanded programs that attract low-income enrollees who would normally be part of the ACA Marketplace, the KFF researchers said.

The states with the highest enrollment increases were Texas (up 255%), Mississippi (up 242%), West Virginia (up 234%), Louisiana (up 234%), Georgia (up 227%) and Tennessee (up 221%).

The KFF researchers noted that the rise in ACA Marketplace enrollment was largely carried by states in which Trump won in 2024. Since 2020, 88% of the total ACA Marketplace growth came from states where Trump won.

Sara Heath has covered news related to patient engagement and health equity since 2015.