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Analysis of ACA Individual Market Trends for 2026

Wakely Consulting Group, part of HMA, has published a critical analysis focusing on the Affordable Care Act (ACA) individual market, revealing meaningful shifts in enrollment patterns and consumer behavior as we advance through 2026. Utilizing data that reflects approximately 80% of the market, these findings could shape pricing strategies, participation rates, and policy implications as we move toward 2027.

Key Highlights

The current analysis indicates that while initial reports suggested only minor decreases in enrollment, further investigation into premium payment habits presents a more intricate scenario. On average, only 86% of enrollees made their first premium payments in January 2026, with considerable differences noted across various states.

Michelle Anderson, a Wakely actuary and the report’s coauthor, remarked, “This moment represents a transition within the individual market, differing from recent years. We observe not just shifts in enrollment numbers but also a change in the characteristics of covered members and the plans they select, along with an overall alteration in the market's risk profile.”

Major Findings of the Analysis

• - Significant Declines in Enrollment: Despite plan selections declining by about 5%, actual enrollment is forecasted to decrease sharply – anywhere between 17% to 26% on average, depending on unpaid premiums and ongoing attrition. Some states might witness drops exceeding 26%, particularly in those operating under a Federally Facilitated Exchange.

• - Premium Payment Behavior: Examined behavior surrounding premium payments emerged as a pivotal marker for market stability. States with notable premium hikes and high rates of automatic reenrollment displayed lower payment rates, suggesting potential coverage losses as the year progresses.

• - Shifts Toward Lower-Cost Plans: The analysis notes a significant movement towards lower-cost coverage options, characterized by an increased preference for Bronze plans, while participation in Silver plans has declined. This shift indicates that affordability pressures compel consumers to accept higher out-of-pocket costs in exchange for reduced premiums.

• - Worsening Risk Pool: Expectations for the risk pool point towards an increase in morbidity by 2.9% to 6.5% in 2026, influenced by a trend where healthier individuals are opting out of the market.

• - State-Level Variability: The report illustrates pronounced variations at the state level. Exchanges established at the state level generally retained more enrollees, experiencing less disruption than their Federally Facilitated counterparts, highlighting the critical role of localized policy and program design.

Michael Cohen, another coauthor, emphasized, “These insights demonstrate a degree of uncertainty that insurers and policymakers need to navigate effectively. Changes in enrollment, plan choices, and health conditions of members will influence the development of premium rates and engagement in the market as we approach 2027.”

Market Implications Ahead

The combination of expired enhanced premium tax credits and escalating healthcare costs, alongside eligibility policy shifts, has contributed to a more unpredictable environment for stakeholders. The findings indicate a need for continuous monitoring of evolving data throughout 2026 to grasp the nature of these ongoing trends and facilitate informed decision-making around pricing, participation, and policy strategies.

Chia Yi Chin, also a coauthor, suggests that a central question remains, not just regarding how the market might constrict, but how its makeup will transform. “Our analysis draws from preliminary data, and we are dedicated to providing ongoing insights to stakeholders over the coming months.”

About the Analysis

This comprehensive study derives insights from a proprietary dataset collected from over 75 carriers, encompassing more than 30 markets and representing a significant share of ACA-compliant enrollment. It delves into premium payment behaviors, enrollment dynamics, and risk trends to offer an early glimpse of the emerging market landscape for 2026.

About Wakely Consulting Group

Founded in 1999, Wakely Consulting Group is renowned for its exceptional healthcare actuarial consulting services. With locations nationwide, Wakely possesses deep expertise in diverse areas like Medicare Advantage, Medicaid managed care, risk adjustment, and market strategy development. Their team brings substantial experience across the healthcare spectrum, collaborating with insurers, healthcare providers, and government bodies.