On April 15, 2026, Wakely Consulting Group, a Health Management Associates, Inc. Company, released a paper titled, Who Paid, and Who Stayed? Early 2026 Enrollment Trends in the Individual Market.1[1] In this paper, we estimate a material reduction in individual ACA enrollment for 2026, ranging on average from 17% to 26% in total. We estimate that morbidity could be, on average, between 2.9% and 6.5% worse as a result. This analysis was based on a unique data collection from the Wakely National Risk Adjustment Reporting (WNRAR) project.[2] This paper contains insights not provided by publicly available data releases.
Separately, on March 27, 2026, the Centers for Medicaid & Medicare Services (CMS) released its 2026 Affordable Care Act (ACA) Open Enrollment (OE) Report, which shows a 5% reduction in plan selection enrollment. This accounts for final OE activity and includes key data, including metal mix of those who selected a plan, which had not previously been published. This is likely the most comprehensive market-wide OE data that will be made public.
This paper summarizes key insights based on an evaluation of the OE data, explains the differences between the OE data and Wakely findings, and builds on concepts presented in our Who Paid, and Who Stayed? Early 2026 Enrollment Trends in the Individual Market paper and prior OE analyses.[3],[4]
Key findings:
- Plan selections decreased by 5% in total, with new consumers decreasing by 13%. However, after accounting for those that may not pay their premium, we estimate enrollment may decrease materially, ranging on average from 17% to 26% in total. The decrease in plan selections is more dramatic for states that expanded Medicaid and less significant among State-Based Exchange (SBEs).
- Significant metal and Cost Share Reduction (CSR) shifts suggest consumers are “buying down” to leaner coverage for lower net premiums (e.g., proportion of Bronze plan selections increased 10%, from 30% to 40%).
- The proportion of active shoppers increased from 38% to 46%, while the proportion of automatic re-enrollees decreased. Those who actively shopped experienced a lower increase in net premium.
- In general, brokers appeared to help maintain enrollment.
- High-level/nationwide themes are helpful but tell only part of the story. There was significant variation between states, ranging from a year-over-year plan selection increase of 18% to a decrease of 22%. Understanding state-level dynamics and nuance is important for understanding state-level outcomes.
HMA Managing Director Zach Sherman was contributed to this white paper.
[1] https://www.wakely.com/wp-content/uploads/2026/04/Who-Paid-and-Who-Stayed-%E2%80%93-Early-2026-Enrollment-Trends-in-the-Individual-Market.pdf
[2] For information on how to participate in the WNRAR project and receive issuer level insights in the future, please contact the authors.
[3] https://www.healthmanagement.com/blog/hmas-take-on-2026-aca-marketplace-open-enrollment-snapshot/
[4] https://www.wakely.com/wp-content/uploads/2026/01/Individual-ACA-Open-Enrollment-Insights-So-Far.pdf
