Michigan Affordable Care Act marketplace enrollment slumps amid rising costs

Newly released data show that about 357,000 Michiganders held active ACA marketplace coverage in February, down 27% from 2025
The state ranks near the top nationally in enrollment losses, by both count and rate
Federal officials credit an anti-fraud crackdown, while analysts point to the expiration of enhanced premium subsidies amid other rising health care costs

About 130,000 fewer Michiganders were enrolled in Affordable Care Act marketplace coverage this February compared with last year, according to new federal data.

The state’s shrinking coverage — a loss of roughly 1 in 4 people covered — follows a national trend: nearly 3 million Americans lost or dropped marketplace coverage amid rising costs tied to the expiration of enhanced premium subsidies, ending a years-long tear of signups that began during the COVID-19 emergency. In Michigan, plans on the individual marketplace went up about 20% in 2026.

Here’s what you need to know:

End of an era

Some 357,000 people in the state were enrolled in plans offered by HealthCare.gov as of February, according to the US Centers for Medicare & Medicaid Services, noting a key metric the government uses to count people with active coverage.

While thousands signed up for ACA coverage going into 2026, many did not pay their initial premium at the beginning of the new year, so their plans never took effect or their coverage was canceled.

“This is the first time we’ve seen state-level data that shows how much ACA marketplace enrollment truly fell,” said Cynthia Cox, vice president and director of the ACA program at the health care research nonprofit KFF, told the Associated Press. “It’s in line with our expectations, but it does show a very steep drop in the number of people with ACA coverage.”

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The decline is Michigan’s first in six years, ending a pandemic-era run of growth. The state reached its highest enrollment on record in June 2025, at 501,806.

Michigan tops most states

The state is seeing some of the most drastic ACA enrollment losses in the US, ranking sixth in the nation for total number of people who have ceased coverage through the program. Florida leads the country in total disenrollment from last year with more than 442,000, followed by North Carolina, Ohio, South Carolina and Texas.

Michigan’s 27% year-over-year decline is the seventh steepest in the country. Ohio leads the nation at 32%, followed by Oklahoma, Arizona, South Carolina, Minnesota and Indiana. Enrollment rates are down 13% nationally.

Still shrinking

Even after open enrollment closed mid-January, Michigan’s marketplace continued to contract.

Net enrollment in the state’s Obamacare plans fell about 9,500 between January and February, meaning cancellations and terminations outpaced the number of new signups outside of the standard open enrollment window

That reverses the recent pattern of growth — enrollment grew by about 2,960 over the same stretch in 2025 and by more than 17,000 in 2024.

What the experts say

In a report released last week, the US Department of Health and Human Services suggested the significant drop in enrollment this year could be attributed to a federal crackdown on fraudulent or “phantom” enrollment. But analysts have said it was more likely related to the Jan. 1 expiration of federal subsidies, and other changes, including tightened requirements on which immigrants could access subsidized plans.

The price pressures are “only getting worse” due to hospital prices, labor costs and increased use of medications like GLP-1s, according to Dr. Mark Fendrick, who directs the Center for Value-Based Insurance Design at the University of Michigan.

“There’s every reason to think that premiums will continue to rise,” Fendrick told Bridge Michigan. “If you make people pay more for something, they buy less of it.”

Did you lose your ACA coverage? Let us know: enewman@bridgemi.com

The Associated Press contributed to this report.

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