Following the expiry of enhanced subsidies for Affordable Care Act (ACA) plans at the beginning of this year, many enrollees in marketplace coverage are seeing a significant rise in their costs, according to a new survey.
In late 2025, researchers at KFF polled 1,350 adults enrolled in ACA plans to learn more about how they were preparing for the enhanced tax credits to run out. Now, the organization has followed up with 1,117 of those respondents and found that 51% who returned to a marketplace plan in 2026 say their costs are "a lot higher."
Most (80%) of those who reenrolled in an ACA plan said their premiums, deductibles or coinsurance and copayments have increased this year.
Close to three-quarters (73%) of those surveyed said they are either very or somewhat worried about their ability to afford emergency care or hospitalizations in their current plans. Forty-nine percent expressed concern about affording routine medical visits, and 45% said the same about prescriptions.
"While most 2025 Marketplace enrollees say they still have Marketplace coverage in 2026, having insurance does not insulate them from worrying about the costs of accessing care," the researchers wrote.
In addition to the affordability of services, 17% of the respondents who reenrolled in an ACA plan said they are not sure they can cover the cost of their insurance premium for the entirety of 2026.
The poll found that a quarter of people who switched plans downgraded to a lower metal tier, as premiums tend to be lower and out-of-pocket costs are generally higher. Nine percent of those surveyed said they are currently uninsured, and 28% said they switched to a different plan on the marketplaces.
Most of those surveyed (69%) are still enrolled in a marketplace plan, while 22% switched to a different program such as Medicaid or an employer-sponsored plan.
The youngest enrollees, between ages 18 and 29, were more likely to exit the market entirely, with 49% saying they were no longer enrolled in a marketplace plan and 14% saying they're currently uninsured.
Of the people who switched to a different ACA plan or became uninsured, 71% said the cost was a major factor in their decision.
When asked who carries the blame for the rising costs they're experiencing, 70% of those who reenrolled in an ACA plan said health insurers share "a lot" of the blame. More than half (54%) said the same about Republicans in Congress, and 53% said President Donald Trump holds "a lot" of the blame.
In addition, 52% said pharmaceutical companies bear a lot of the blame for rising costs.
Echoing a finding from the December survey, 48% of those in marketplaces plans said their healthcare costs will have a major impact on who they choose to vote for in the midterm elections this fall.
"Beyond being motivated to vote, some enrollees have taken actions to discuss their rising healthcare costs with friends and family, online, or by directly contacting an elected official," the KFF researchers wrote.