How many people are enrolled in Affordable Care Act plans in the US?
Refreshed annually
About 23.1 million in 2026. That’s an estimated 6.8% of the US population based on enrollments by the end of the open enrollment period (which, in most states, typically runs from early November to mid-January of the next year). Qualified health plans are insurance plans certified by the Health Insurance Marketplace that comply with Affordable Care Act (ACA) requirements. They provide health benefits and follow established cost-sharing limits, including deductibles, copayments, and out-of-pocket maximums.
23.1M
enrolled in qualified health plans (2026)
6.8%
of the US population enrolled in qualified health plans (2026)
Qualified health plans were first offered during the 2014 open enrollment period. Enrollment was at 11.7 million people in 2015. At its peak in 2025, enrollment more than doubled compared to 2015, reaching 24.3 million people.
In 2026, enrollment in ACA health plans was 4.9% lower than in 2025.
Number of people enrolled in qualified health plans, by year
Qualified health plan enrollment hovered around 11 to 12 million people from 2015 to 2021. The largest single-year change during this period was an 8.5% (or 993,800 people) increase in enrollment from 2015 to 2016.
Enhanced ACA health insurance tax credits started in March 2021 and continued through December 2025. The first open enrollment period to reflect these changes was the 2022 plan year, when enrollment rose to about 14.5 million people. Enrollment continued rising through 2025, with the largest increase between 2023 and 2024, rising by 5.09 million people or about 31.1%.
Enhanced ACA health insurance tax credits are temporary expansions of the ACA’s existing premium tax credit. These enhanced credits:
- Remove the income cap for eligibility (previously 400% of the Federal Poverty Level)
- Limit household premium contributions to 8.5% of income
The enrollment growth between 2023 and 2024 coincided with the end of the Medicaid continuous enrollment program. During the COVID-19 pandemic, the federal government provided states with additional Medicaid funding to maintain continuous coverage. This coverage meant that Medicaid enrollees could keep their benefits without the usual eligibility checks or renewals, preventing health insurance gaps during the public health emergency. This policy was in effect from 2020 through March 2023. Individuals who lost their Medicaid or CHIP coverage at the end of this program needed to transition to other health insurance, such as coverage through a Health Insurance Marketplace.
Which states have the highest and lowest enrollment?
In 2026 enrollment in qualified health plans varied by state, ranging from 1.1% of the population in New York to 19.3% of the population in Florida.
The percent of state populations enrolled in qualified health plans ranged from 1.1% in New York to 19.3% in Florida.
Estimated percentage of people enrolled in qualified health plans as a share of the population, by state (2026)
The three states with the lowest enrollment percentage in 2026 were:
- New York at 1.1%
- Hawaii at 1.6%
- Kentucky at 1.9%
The highest enrollment percentages were in:
- Florida at 19.3%
- Texas at 13.2%
- Georgia at 11.7%
How many people receive ACA financial assistance?
People enrolled in ACA plans by state, 2026.
| State | Number of people enrolled in ACA plans | % of the state population enrolled in ACA plans | Number of people receiving federal ACA financial assistance | % of the state population receiving federal ACA financial assistance |
|---|---|---|---|---|
Alabama | 455,800 | 8.8% | 415,600 | 8.0% |
Alaska | 26,100 | 3.5% | 19,800 | 2.7% |
Arizona | 357,100 | 4.7% | 296,200 | 3.9% |
Arkansas | 160,300 | 5.1% | 139,600 | 4.5% |
California | 1.93M | 4.9% | 1.58M | 4.0% |
Colorado | 277,200 | 4.6% | 192,100 | 3.2% |
Connecticut | 156,700 | 4.2% | 123,900 | 3.4% |
Delaware | 44,700 | 4.2% | 36,100 | 3.4% |
District of Columbia | 16,100 | 2.3% | 3,000 | 0.4% |
Florida | 4.54M | 19.3% | 4.3M | 18.3% |
Of the people enrolled in qualified health plans, about 86.7% receive the Advance Premium Tax Credit (APTC) and/or cost-sharing reductions in 2026. This accounts for about 5.9% of the US population.
Eligible individuals can apply for APTCs in advance to reduce their monthly health insurance premiums. At year’s end, their actual income determines whether they must repay any excess credit or receive additional funds.
Cost-sharing reductions are discounts that lower deductibles, copayments, and coinsurance. They also reduce out-of-pocket maximums, aka the most a patient would pay for covered services in a year. Insurance pays for 100% of all covered services once a patient hits that maximum.
86.7% of people in ACA plans in 2026 received financial assistance.
Percentage of people enrolled in qualified health plans receiving APTC and/or CSRs
86.6%
of people enrolled in QHPs qualified for an APTC (2026)
37.1%
of people enrolled in QHPs qualified for CSRs (2026)
How much do APTCs reduce monthly premium costs?
In 2026, APTCs lowered consumers' average monthly premium cost by $563, an 76% reduction. Nationwide, average reductions ranged from 21.7% in New York to 87.4% in Texas. In Washington, DC, the reduction was 11%.
2026 APTC average premium discounts ranged from 21.7% in New York to 87.4% in Texas.
Percent difference between average premium and average premium after APTC, by state, (2026)
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Methodology
USAFacts standardizes data, in areas such as time and demographics, to make it easier to understand and compare.
Page sources
USAFacts endeavors to share the most up-to-date information available. We sourced the data on this page directly from government agencies; however, the intervals at which agencies publish updated data vary.