The Centers for Medicare & Medicaid Services (CMS) has released its final tally of signups, automatic re-enrollments and plan choices during this year’s highly watched open enrollment period.
In total, the agency said there were 23.1 million signs-ups during the 2026 Open Enrollment Period, a 5% decline, or 1.2 million people, compared to 2025. That said, 2026 enrollments were still 8%, or 1.7 million people, higher than in 2024.
Between Nov. 1, 2025, and Jan. 15, 2026, 15.8 million plans were selected through the HealthCare.gov platform, while 7.4 million were chosen via a state-based exchange. New customers selecting exchange coverage during the period dropped 13% year over year, to 3.6 million; automatic re-enrollees decreased by 19%, to 8.8 million; and active re-enrollees rose by 15%, to 10.7 million.
A CMS release accompanying the report said the totals, still the second-highest on record, reflected the exchanges’ “continued strength and stability.”
The agency also highlighted “significant enforcement action” the agency took to address improper enrollments, some of which had been paused during the COVID-19 pandemic. For instance, the agency said it ended advance payment of either the premium tax credit or coverage for almost 1.5 million people found to be ineligible or enrolled on HealthCare.gov without their authorization.
“This reduced the number of people who would otherwise be returning customers during the 2026 [Open Enrollment Period],” the agency wrote in its annual report, released Friday.
Other major shifts during this year’s period revolved around the types of plans consumers were choosing.
Compared to the prior year, silver plans dropped from 56% of selected plans in 2025 to 43% in 2026. Meanwhile, bronze plans rose from 30% to 40% and gold from 13% to 17%. Further, with all bronze and catastrophic plans now eligible for a health savings account (HSA) due to changes with last year’s One Big Beautiful Bill Act, the portion of consumers who chose an HSA-eligible plan skyrocketed from 2% to 43%.
A smaller portion of consumers chose plans with financial assistance compared to the prior Open Enrollment Period. Enrollees with an advanced payment premium tax credit dipped from 92% to 87%, while the portion with cost-sharing reductions dropped from 51% to 37%.
Average monthly premiums also rose for enrollees from year to year, both before ($619 to $741) and after the application of advanced payment premium tax credits ($113 to $178), and when only looking at those who received the credit ($74 to $96).
CMS’ numbers paint the impact of high-profile policy changes spearheaded by Republicans over the past year, including the heavy focus on improper enrollments and Congress’ decision to allow enhanced subsidies for marketplace plans to expire at the end of last year.
The latter in particular raised alarms across the healthcare industry of likely increases to premiums, uninsurance and enrollment in lower-tier plans. These could increase patients’ risk of unpayable medical bills and, for hospitals, could fuel an increase in uncompensated care.
As an alternative means to access care within consumers’ budgets, the administration has said it intends to roll back limits on nonstandard plans that can be offered on the exchanges, such as by expanding the pool of individuals who are permitted to choose catastrophic coverage.