{"id":428621,"date":"2026-01-25T08:02:19","date_gmt":"2026-01-25T08:02:19","guid":{"rendered":"https:\/\/www.newsbeep.com\/us\/428621\/"},"modified":"2026-01-25T08:02:19","modified_gmt":"2026-01-25T08:02:19","slug":"key-facts-on-affordable-care-act-obamacare-insurance-exchanges","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/us\/428621\/","title":{"rendered":"Key facts on Affordable Care Act (Obamacare) insurance exchanges"},"content":{"rendered":"

Nearly 23 million Americans get health insurance through one of the online \u201cexchanges\u201d (also called \u201cmarketplaces\u201d) that operate under the 2010 Affordable Care Act<\/a>, or ACA. Most receive subsidies from the federal government to lower their premiums and out-of-pocket costs.<\/p>\n

In 2021, Congress enhanced the law\u2019s original subsidies and extended them to more people. But those changes expired at the end of 2025, meaning that millions of people now face higher insurance costs. The nonpartisan Congressional Budget Office estimates that 4.2 million more people<\/a> will be uninsured by 2034 as a direct result of Congress not extending the enhanced subsidies.<\/p>\n

The ACA made many changes to the U.S. health care system, from expanding Medicaid eligibility<\/a> to prohibiting insurers from denying coverage based on preexisting conditions. But in many ways, the exchanges are the heart of the law. Here are answers to some common questions about the exchanges and how they work.<\/p>\n

About this research<\/p>\n

This Pew Research Center analysis explains the health insurance exchanges created by the 2010 Affordable Care Act (known as the ACA or Obamacare) and how many people use them. It also estimates how the expiration of enhanced subsidies will affect the insurance premiums people pay.<\/p>\n

Why did we do this?<\/p>\n

The Center conducts high-quality research to inform the public, journalists and leaders. The debate over the ACA has shaped American politics for more than 15 years.<\/p>\n

Learn more about Pew Research Center.<\/a><\/p>\n

How did we do this?<\/p>\n

This analysis largely relies on data compiled by the Centers for Medicare & Medicaid Services<\/a>, the federal agency that oversees the ACA exchanges. We were greatly aided by background material from KFF<\/a>, a nonpartisan research organization focused on health policy, and the Congressional Research Service<\/a>.<\/p>\n

To get an idea of how much the government spends on ACA subsidies, we also used archived data from the Office of Management and Budget, accessed via the Internet Archive\u2019s Wayback Machine<\/a> service, and Treasury Department data on tax expenditures<\/a>.<\/p>\n

What exactly is an ACA exchange?<\/p>\n

Exchanges are online platforms where people can compare and buy different health insurance plans offered by private insurers. In 28 states, the federal government operates the exchanges under the common name HealthCare.gov<\/a>; 22 states and the District of Columbia run their own exchanges. (There are separate exchanges for individuals and small businesses, but this analysis focuses on the individual ones, which are far more widely used.)<\/p>\n

Congress created the exchanges to serve people who don\u2019t qualify for Medicaid or other public insurance (because they make too much money, don\u2019t meet residency requirements or another reason) and don\u2019t have access to affordable, employer-sponsored insurance.<\/p>\n

People can shop for insurance during the open enrollment period, which typically runs from November through mid-January. People who experience certain life events \u2013 such as moving, getting married, losing a job or having a baby \u2013 may also be able to enroll at other times of the year.<\/p>\n

How many people use the exchanges?<\/p>\n

ACA enrollment numbers took off after Congress enhanced subsidies and extended eligibility in 2021<\/p>\n

Total average effectuated enrollment in ACA exchange plans, in millions<\/p>\n

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Note: \u201cEffectuated enrollment\u201d refers to people who have chosen a health insurance plan on an exchange and paid the first month\u2019s premium.
Source: Centers for Medicare & Medicaid Services.<\/p>\n

PEW RESEARCH CENTER<\/p>\n

\t\t\t\t\t\t\tShare on X<\/p>\n

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ACA enrollment numbers took off after Congress enhanced subsidies and extended eligibility in 2021<\/p>\n

Total average effectuated enrollment in ACA exchange plans, in millions<\/p>\n

DateEnrollment (millions)02\/01\/201710.302\/01\/201810.602\/01\/201910.602\/01\/202010.702\/01\/202111.202\/01\/202213.802\/01\/202315.702\/01\/202420.802\/01\/202523.4<\/p>\n

Note: \u201cEffectuated enrollment\u201d refers to people who have chosen a health insurance plan on an exchange and paid the first month\u2019s premium.
Source: Centers for Medicare & Medicaid Services.<\/p>\n

PEW RESEARCH CENTER<\/p>\n

ChartDataShare<\/p>\n

About 22.8 million people selected a plan from either the federal exchange or a state-run exchange during the open enrollment period for 2026, compared with 24.3 million who did so a year earlier. In previous years, more than 95% of people who chose a plan officially enrolled in one, by paying the first month\u2019s premium. For example, in 2025 about 23.4 million people did so.<\/p>\n

Before the start of the COVID-19 pandemic<\/a>, enrollment via the exchanges plateaued at around 10.5 million people. But it surged after Congress enhanced the premium subsidies in 2021.<\/p>\n

Still, only about 6.9% of the total U.S. population buys health insurance through the ACA exchanges. By contrast, 64.4 million Americans (19.1% of the population) were covered by Medicare in 2024, the most recent year for which data is available, and 59.4 million were covered by Medicaid (17.6%).<\/p>\n

Related: What the data says about Medicaid<\/a><\/p>\n

What kind of health insurance plans are available on the exchanges?<\/p>\n

All plans sold on ACA exchanges have to cover a set of \u201cessential health benefits,\u201d<\/a> though the precise services vary by state.<\/p>\n

As in the regular insurance market, exchange plans can have different premiums, deductibles, copayments, covered services and reimbursement rates. To help consumers sort through all that, exchange plans are sorted into four tiers<\/a>, based on how much of patients\u2019 covered health care costs they pay on average (that is, not for any specific customer or claim):<\/p>\n

Platinum: 90% of costs covered, on average<\/p>\n

Gold: 80%<\/p>\n

Silver: 70% (or possibly more depending on income)<\/p>\n

Bronze: 60%<\/p>\n

In general, Platinum and Gold plans have the highest premiums and lowest deductibles, while Bronze plans have the lowest premiums and highest deductibles. There also are \u201cCatastrophic\u201d plans, with very low premiums and very high deductibles, but they\u2019re only available to certain people. Fewer than 1% of exchange customers opt for Catastrophic plans.<\/p>\n

In some cases, people who choose Silver plans \u2013 but no others \u2013 can get extra federal subsidies that lower their copayments and other out-of-pocket costs. Those subsidies, which are known as \u201ccost-sharing reductions\u201d and vary depending on income, can raise Silver plans\u2019 payout shares to as much as 96%.<\/p>\n

Perhaps for that reason, Silver plans are by far the most popular. More than half (56%) of all plans selected on all exchanges during the pre-2025 open enrollment period were Silver, according to the Center for Medicare & Medicaid Services, the federal agency that oversees the exchanges.<\/p>\n

How do federal subsidies under the ACA work?<\/p>\n

Besides the cost sharing reductions mentioned above, the main subsidy under the ACA is the \u201cpremium tax credit,\u201d or PTC. Though structured as an income tax credit, the practical effect of the PTC is to reduce insurance premiums.<\/p>\n

ACA premium subsidies have become more generous in recent years<\/p>\n

Average monthly advance premium tax credit, for exchange customers receiving them<\/p>\n

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Source: Centers for Medicare & Medicaid Services.<\/p>\n

PEW RESEARCH CENTER<\/p>\n

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ACA premium subsidies have become more generous in recent years<\/p>\n

Average monthly advance premium tax credit, for exchange customers receiving them<\/p>\n

YearAverage APTC2016$290.082017$373.062018$517.612019$512.112020$492.73 2021$508.732022$504.132023$519.562024$527.64<\/p>\n

Source: Centers for Medicare & Medicaid Services.<\/p>\n

PEW RESEARCH CENTER<\/p>\n

ChartDataShare<\/p>\n

The dollar amount of the PTC depends on both a buyer\u2019s income and how much insurance costs in their marketplace area. It\u2019s calculated by subtracting the buyer\u2019s \u201crequired contribution\u201d from the actual cost of the second cheapest Silver plan (called the \u201cbenchmark\u201d plan) available on their exchange. The required contribution, in turn, is a percentage of the buyer\u2019s income, which rises as income does.<\/p>\n

Although the PTC is based on the benchmark plan, exchange customers can use it to buy any available plan. And unlike most tax credits, the PTC can be taken in advance in monthly chunks \u2013 allowing it to reduce a person\u2019s monthly premium. The PTC, like other tax credits, also can be claimed in full at tax time, but few people go that route. As of February 2025, more than 93% of all enrollees took the advance credit.<\/p>\n

What were the enhanced subsidies that expired at the end of 2025?<\/p>\n

Expiration of enhanced ACA subsidies means many Americans will spend more on health insurance<\/p>\n

Income share of \u201crequired minimum contribution\u201d toward insurance premiums<\/p>\n

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Source: IRS.<\/p>\n

PEW RESEARCH CENTER<\/p>\n

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Expiration of enhanced ACA subsidies means many Americans will spend more on health insurance<\/p>\n

Income share of \u201crequired minimum contribution\u201d toward insurance premiums<\/p>\n

Household income (as share of federal poverty line)2021-252026Less than 133%2.10%At least 133% but less than 150%3.14%-4.19%Less than 150%0.00%At least 150% but less than 200%0.0%-2.0%4.19%-6.60%At least 200% but less than 250%2.0%-4.0%6.60%-8.44%At least 250% but less than 300%4.0%-6.0%8.44%-9.96%At least 300% but less than 400%6.0%-8.5%300% to 400%9.96%400% and higher8.5%No subsidy<\/p>\n

Source: IRS.<\/p>\n

PEW RESEARCH CENTER<\/p>\n

ChartDataShare<\/p>\n

In 2021, Congress made the premium tax credits more generous and made more people eligible for them. Before these changes, the required contribution percentages ranged from 2.07% to 9.86% of income. Afterward, they ranged from zero percent to 8.5%. The law also extended subsidies to people whose income exceeded 400% of the federal poverty level<\/a> (which itself varies by household type). Previously, 400% was the upper limit.<\/p>\n

At first, those enhancements were only in place for 2021 and 2022. A later law extended them to the end of 2025. Extending them further was a key Democratic demand<\/a> during last year\u2019s record-long government shutdown. As of Jan. 21, Congress has not agreed on a deal to extend the enhanced subsidies, leaving the original ones in effect. <\/p>\n

How much of a difference did the enhanced subsidies make?<\/p>\n

As of February 2025, the advance premium tax credit, or APTC, shaved 83% off the average monthly premium. Before the subsidies were enhanced in 2021, the APTC cut roughly three-quarters of the monthly cost. But the impact can vary considerably among buyers in different circumstances.<\/p>\n

To get a sense of that variability, we used the ACA Enhanced Premium Tax Credit Calculator<\/a> from KFF, a nonpartisan research organization focused on health policy, to estimate the impact of the enhanced subsidies on households of varying compositions and income levels around the country. (The estimates were made in mid-December, before the enhancements expired.) Overall, KFF estimates suggest that the enhancements benefited people of moderate incomes the most.<\/p>\n

For example, a family of five in south-central Idaho making $100,000 a year would pay $385 a month for a Silver plan with the enhancements, but $743 a month without them. A family of four making $150,000 annually in the Orlando, Florida, area would see its monthly insurance bill rise from $1,063 to $1,880 without enhancements. And the premium for a couple making $200,000 a year in San Luis Obispo County, California, would nearly double, from $1,417 to $2,733 a month.<\/p>\n

How much will losing enhanced Affordable Care Act subsidies cost people? It depends on who they are and where they live<\/p>\n

Monthly cost for a Silver plan under the Affordable Care Act<\/p>\n

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* In this scenario, at the $25,000 household income level, the adults would not be eligible for either Medicaid or financial assistance through the Affordable Care Act. The children likely would be eligible for Medicaid or Children\u2019s Health Insurance Program at the $25,000 and $50,000 household income levels, and so are excluded from those estimates.
Source: Pew Research Center analysis using KFF\u2019s ACA Enhanced Premium Tax Credit Calculator.<\/p>\n

PEW RESEARCH CENTER<\/p>\n

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How much will losing enhanced Affordable Care Act subsidies cost people? It depends on who they are and where they live<\/p>\n

Monthly cost for a Silver plan under the Affordable Care Act<\/p>\n

Example ScenariosMonthly cost with enhanced premium tax creditMonthly cost without enhanced premium tax creditEXAMPLE 1:Location:Twin Falls County, Idaho# of adults:2 (ages 37, 33)# of children:3 (ages 13, 10, 8)Yearly household income
(in 2026 dollars)With enhanced premium tax creditWithout enhanced premium tax credit$25,000 Likely eligible for MedicaidLikely eligible for Medicaid$50,000 Likely eligible for MedicaidLikely eligible for Medicaid$75,000 $123$410$100,000 $385$743$150,000 $1,058$1,245$200,000 $1,417$1,896EXAMPLE 2:Location:San Luis Obispo County, California# of adults:2 (ages 59, 55)# of children:0Yearly household income
(in 2026 dollars)With enhanced premium tax creditWithout enhanced premium tax credit$25,000 Likely eligible for MedicaidLikely eligible for Medicaid$50,000 $144$331$75,000 $461$623$100,000 $708$2,733$150,000 $1,063$2,733$200,000 $1,417$2,733EXAMPLE 3:Location:Orange County, Florida*# of adults:2 (ages 25, 23)# of children:2 (ages 3, 1)Yearly household income
(in 2026 dollars)With enhanced premium tax creditWithout enhanced premium tax credit$25,000 $1,066$1,066$50,000 $9$186$75,000 $208$489$100,000 $523$830$150,000 $1,063$1,880$200,000 $1,417$1,880EXAMPLE 4:Location:Boone County, Missouri# of adults:2 (ages 23, 21)# of children:0Yearly household income
(in 2026 dollars)With enhanced premium tax creditWithout enhanced premium tax credit$25,000 Likely eligible for MedicaidLikely eligible for Medicaid$50,000 $144$331$75,000 $461$623$100,000 $708$1,119$150,000 $1,063$1,119$200,000 $1,119$1,119<\/p>\n

* In this scenario, at the $25,000 household income level, the adults would not be eligible for either Medicaid or financial assistance through the Affordable Care Act. The children likely would be eligible for Medicaid or Children\u2019s Health Insurance Program at the $25,000 and $50,000 household income levels, and so are excluded from those estimates.
Source: Pew Research Center analysis using KFF\u2019s ACA Enhanced Premium Tax Credit Calculator.<\/p>\n

PEW RESEARCH CENTER<\/p>\n

ChartDataShare<\/p>\n

How many people receive subsidies under the ACA?<\/p>\n

As of February 2025, 21.8 million enrollees took the advance premium tax credit (APTC) subsidy (93.3% of enrollees), and 12.5 million (53.5%) received the cost-sharing reductions.<\/p>\n

These percentages are higher than in February 2020 \u2013 before Congress expanded the subsidies \u2013 when 86.5% of enrollees received the advance PTC, and 50.1% received cost-sharing reductions.<\/p>\n

But some critics say the PTC program is rife with fraud<\/a>, citing that as a reason to let the enhancements expire.<\/p>\n

The Centers for Medicare & Medicaid Services has reported<\/a> that it made $925.7 million in improper subsidy payments in 2022 \u2013 about 1.6% of all the PTC subsidies it paid that year. Last year two Florida insurance brokers were convicted of enrolling ineligible people<\/a>, collecting millions of dollars in fraudulent commissions. And a recent report<\/a> by the Government Accountability Office found weaknesses in CMS\u2019s systems for preventing fraud, such that auditors were able to enroll fictitious people with incomplete or missing information.<\/p>\n

How much does the federal government spend on ACA subsidies?<\/p>\n

The exact amount the government spends on subsidies depends on who\u2019s counting and how they\u2019re doing it, but it\u2019s a considerable sum any way you look at it:<\/p>\n","protected":false},"excerpt":{"rendered":"Nearly 23 million Americans get health insurance through one of the online \u201cexchanges\u201d (also called \u201cmarketplaces\u201d) that operate…\n","protected":false},"author":2,"featured_media":428622,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[59],"tags":[97,252,253],"class_list":{"0":"post-428621","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health-care","8":"tag-health","9":"tag-health-care","10":"tag-healthcare"},"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/428621","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/comments?post=428621"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/428621\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media\/428622"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media?parent=428621"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/categories?post=428621"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/tags?post=428621"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}