KFF conducted a probability-based survey of covered by ACA Marketplace plans in late 2025 to better understand their worries about potential cost increases for their health coverage. Now—without the enhanced tax credits in place—KFF re-interviewed 1,117 individuals (more than 80% of the original sample) to learn how they are navigating these changes to the ACA Marketplace.

• In all, a large majority (80%) of these enrollees say their health care costs, which can include premiums, deductibles, co-pays, or coinsurance, are higher.
• Three in four (73%) returning Marketplace enrollees say they are “very worried” or “somewhat worried” about being able to afford costs for emergency care or hospitalizations while about half are worried about affording costs for routine medical visits (49%) or prescription drugs (45%)
• A majority (55%) of returning Marketplace enrollees say they are (or will be) cutting back spending on food or basic household items in order to afford the costs of coverage and care.

This KFF Follow-Up Survey of Marketplace Enrollees was designed and analyzed by public opinion researchers at KFF, with data collection, weighting, and tabulation by SSRS. The survey was conducted February 12- March 2, 2026, online and by telephone among a nationally representative sample of 1,117 U.S. adults who had Marketplace insurance in 2025 in English (n=1,079) and in Spanish (n=38). The sample is entirely derived from people who completed the KFF Marketplace Survey in 2025 (n=1,350). The original sample was recruited using two probably-based panels, including the SSRS Opinion Panel.