The ACA individual market is undergoing significant change in 2026. New Wakely analysis of January–July data shows a 15.7% year-over-year decline in enrollment alongside a 6.9% increase in normalized relative risk.
The findings suggest that healthier members may be leaving the market at a higher rate, contributing to a more medically complex risk pool and potentially higher underlying claim costs. The analysis also identifies meaningful differences across State-Based Marketplaces (SBM) and Federally Facilitated Marketplaces (FFM), as well as variation by metal level and state.
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- Enrollment changes across bronze, silver, gold, and platinum plans
- Differences between State-Based Marketplaces and Federally Facilitated Marketplaces
- Changes in normalized relative risk, claimant ratios, and Hierarchical Condition Categories (HCC) prevalence
- The relationship between enrollment attrition and risk pool deterioration
- Potential implications for 2027 and 2028 pricing, forecasting, and market strategy
- Important methodological limitations and sources of uncertainty
Key findings
- Enrollment declined 15.7% nationally from January–July 2025 to January–July 2026.
- Normalized relative risk increased 6.9% over the same period.
- Claimant ratios increased 1.8% year over year.
- FFM states generally experienced more pronounced enrollment reductions and relative risk increases than SBM states.
- State-level results varied substantially, underscoring the importance of market-specific analysis.
- Continued attrition and evolving CMS actions could further affect enrollment and morbidity during the remainder of 2026.
Who should read this report
This analysis is intended for:
- Health plan executives and actuaries
- Individual market pricing and risk adjustment teams
- Marketplace and Medicaid policy leaders
- Investors and analysts covering health insurance markets
- State and federal health policy stakeholders
- Consultants supporting ACA individual market strategy
Report details
- Analysis period: January–July 2026 compared with January–July 2025
- Data source: Wakely National Risk Adjustment Reporting project
- Coverage: More than 80 carriers across 37 states, representing nearly 80% of ACA-compliant individual market enrollment
- Authors: Michelle Anderson, FSA, MAAA; Michael Cohen, PhD; and Zimo Han, ASA, MAAA
