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.

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.)¹ 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.

Is effectuated Marketplace enrollment lower in 2026 than it was in 2025?

Yes, effectuated enrollment in Marketplace health plans is trending lower in 2026 than it was in 2025.

As of February 2026, effectuated Marketplace enrollment stood at about 19.2 million people,² down from about 21.8 million a year earlier.³

The drop-off in effectuated enrollment wasn't unexpected. Fewer people selected plans during open enrollment, so the starting number was lower: For 2026 coverage, 23.1 million people selected plans during open enrollment,⁴ down from 24.3 million people who selected plans the year before.⁵

And net premiums are 58% higher in 2026 than they were in 2025 (due to the expiration of federal subsidy enhancements),⁶ leading more people to be unsure about whether they would be able to afford their premiums for the whole year.⁷

In addition, the low-income special enrollment period, which had allowed year-round enrollment for low-income people since 2021, is no longer available. This special enrollment period had allowed more people to enroll throughout the year, without a specific qualifying life event, which helped to offset some of the normal attrition that we generally see throughout the year. This kept the effectuated enrollment numbers higher than they would have been without the low-income special enrollment period.

Although effectuated enrollment in February 2026 was about 12% lower than it had been in February 2025, some people whose coverage was automatically renewed for 2026 had a three-month grace period, meaning their coverage wouldn’t have terminated for non-payment until the end of March.

So effectuated enrollment has likely continued to fall further behind where it was in 2025. A Wakely analysis projected that “average enrollment in the individual market could shrink 17% to 26% in 2026 compared to 2025 average enrollment."⁸