effectuated enrollment

What is effectuated enrollment?

A person can enroll in a health plan (meaning they can create an account with the exchange or the health insurance company and make a plan selection) without paying any premiums. But if they don't pay their initial premium, the plan never actually takes effect – in other words, it doesn't get effectuated. So the term "effectuated enrollments" is used to describe the number of people who have enrolled in coverage and also paid whatever premiums are due in order for their coverage to take effect and remain in effect.

Millions of people enroll in individual market coverage through the ACA-created health insurance exchanges/Marketplaces each year. The federal government provides data early in the year regarding how many people selected a plan during open enrollment. But some of those people don't pay their initial premiums, and others stop paying their premiums (or actively cancel their policies) later in the year. So effectuated enrollment data give us a clearer picture of how many people actually have coverage.

During the open enrollment period for 2025 coverage, 24.3 million people selected plans in the Marketplaces nationwide.¹ But as of February 2025, effectuated enrollment in the exchanges nationwide stood at about 23.4 million people.² In other words, nearly a million enrollees either didn't effectuate their coverage, or cancelled it within the first several weeks of the year. 

In the individual market, people can cancel their coverage at any point during the year, or just stop paying their premiums and the coverage will terminate. But enrollment outside of open enrollment is mostly limited to those who experience a qualifying life event. (This differs from the employer-sponsored market, where in almost all cases, both enrollments and disenrollments are limited to open enrollment or a special enrollment period triggered by a qualifying life event.)³ So effectuated enrollment in the individual market tends to peak early in the year, right after open enrollment, and then decline slowly throughout the year.

Will effectuated enrollment for 2026 be lower than it was in 2025?

We won't have effectuated enrollment numbers for 2026 Marketplace coverage until at least mid-2026. But stakeholders have expressed concern about a potentially large drop-off in effectuated enrollment due to the expiration of the federal subsidy enhancements at the end of 2025.⁴

Effectuated enrollment in the summer of 2025 (heading into open enrollment for 2026 coverage) was higher than effectuated enrollment had been the year before,⁵ so there were more people whose coverage could be automatically renewed for 2026 than there were for 2025. But given the significant increase in after-subsidy premiums for 2026 (due to the expiration of the federal subsidy enhancements),⁶ it's expected that more autorenewed enrollees might decide not to pay their January 2026 premium, or might not be able to continue making premium payments each month.