A screenshot of the HealthCare.gov marketplace. Enrollment for 2026 fell in Wisconsin and nationwide as premium costs rose and enhanced subsidies ended at the end of 2025.
With premium costs sharply increased and enhanced subsidies to reduce them no longer available, the number of people signing up for health care in the federal marketplace is behind last year by more than 5%, according to a preliminary report.
The federal Centers for Medicare & Medicaid, which manages the HealthCare.gov enrollment,reported this week that Wisconsin enrollment fell by more than 17,000 below 2025’s record enrollment, which topped 310,000. As of Jan. 3, 289,213 Wisconsin residents had enrolled in plans for 2026.
HealthCare.gov is the marketplace created as part of the Affordable Care Act. It is a platform for people to purchase health insurance who aren’t covered by an employer or by some other health plan, such as Medicare or Medicaid.
Nationwide, enrollment for 2026 is 22.77 million, CMS reported — a decline of about 1.5 million from 2025.
The loss of enhanced premium tax credits, which cut the cost of health insurance purchased at HealthCare.gov, has been predicted to lead many to drop out of the marketplace. The enhanced subsidies expired at the end of 2025. Smaller subsidies remain in place, but premiums have also risen in cost, for several reasons.
According to insurance analysts, one factor in that increase was that insurance companies expected the higher prices to drive some people out of the marketplace — particularly those with fewer health concerns who are willing to take the chance that they won’t need coverage.
The remaining population is expected to have more serious health needs, making their care more expensive but also raising the cost for insuring the entire remaining pool of customers.
Open enrollment through HealthCare.gov is still available until Thursday, Jan. 15, with coverage starting Feb. 1. For consumers who enrolled by Dec. 15, 2025, coverage began Jan. 1.
The first deadline for people to sign up for health insurance in 2026 through the federal health care marketplace passed Monday. With the loss of enhanced federal subsidies coverage is forecast to decline after rising for several years. (FS Productions/Getty Images)
When Chiquita Brooks-LaSure stepped into her job overseeing the federal health insurance marketplace in 2021, about 12 million Americans were purchasing their health coverage there.
By the start of 2025, that number had doubled.
Brooks-LaSure served as the administrator for the federal Center for Medicare & Medicaid Services in the Biden administration. In addition to managing the federal health insurance programs for people over 65 and people living at or below the federal poverty guidelines, CMS also manages HealthCare.gov — the health insurance marketplace created by the 2010 Affordable Care Act.
The purpose of the marketplace was to make it easier for people who had neither employer-provided health insurance nor Medicare or Medicaid to purchase a policy that would cover them.
The ACA set standards for what the insurance plans are required to cover, and it established a system of nonprofit navigators to guide buyers as they sought to match their own health needs with the coverage that was available to them on the marketplace.
Early during President Joe Biden’s term, Congress passed and Biden signed legislation that increased tax credit subsidies making insurance plans purchased at HealthCare.gov much more affordable. Those enhanced tax credits brought in a flood of new insurance coverage.
“By the time we left, there were 24 million people who were enrolled” in marketplace health plans purchased through HealthCare.gov, Brooks-LaSure said during a video call with reporters last week. The call was organized by Opportunity Wisconsin, an economic issues messaging and organizing group aligned with the Democratic Party.
The federal move to give people on marketplace health plans larger tax credits drove that increase in enrollment, health policy watchers agree.
Now the enhanced tax credits are due to expire at the end of this year. So far attempts in Congress to extend them, whether permanently or even temporarily, have gone nowhere.
On average, Brooks-LaSure said, premiums for 2026 have gone up by 26%. “For many people, they will choose to not buy health insurance coverage at all,” she said. “But others may choose to buy coverage that doesn’t cover all of their health care needs.”
Monday was the first of two red-letter days in the current history of the ACA and the health care marketplace. People hoping to get coverage starting Jan. 1 were required to sign up by the end of the day.
People can still sign up between now and Jan. 15, but policies won’t take effect until Feb. 1.
After four years of increases in the population with health insurance, the Congressional Budget Office has forecast about 4 million people will drop their coverage in 2026 without the higher subsidies.
“For 275,000 Wisconsinites, these tax credits have saved them on average almost $600 every month,” said Sen. Tammy Baldwin in another call with reporters. “Without them, these Wisconsinites will pay double, triple, or even worse for their premiums next year. And for 30,000 Wisconsinites, the price will be just too high. And they’ll choose to go without insurance.”
That was a decision that Shana Verstegen of Madison said she and her husband briefly considered. Verstegen spoke on Baldwin’s call about the choices the couple is having to make on behalf of themselves and their two sons, ages 7 and 10.
She and her husband both work for a small community gym, Verstegen said. Their employer has too few employees to be able to purchase a group health policy, so they went to the ACA marketplace.
This year they pay $460 a month, already a squeeze, but that will increase to more than $700 a month in 2026, she said.
“It’s an amount we just simply can’t afford,” Verstegen said. Realizing that they could not risk the family’s health by going without coverage, they’ve looked at other options — including possibly giving up work that has been a long-term career in order to find a job with employer-sponsored health insurance.
In the end, Verstegen said, the couple decided to increase their work hours and cancel some events in 2026 to save money to afford their higher-priced health plan.
“These are really tough and frustrating emotional and scary choices,” Verstegen said. “We’re a middle-class, healthy, hard-working family and like so many others we’re simply struggling to keep up.”
Forecasts are murky
Themost recent “snapshot” from CMS on HealthCare.gov enrollment covers Nov. 1-29 this year. In Wisconsin, it shows enrollment down by almost 4,000 people compared to Nov. 1-30, 2024.
Nationally, however, the numbers are up — 5.76 million in November this year compared with 5.36 million a year ago. There isn’t enough data to confidently forecast a trend, however.
Of the people signing up in November, “a lot of those folks were probably people who already had coverage and were either renewing it or picking a new plan, but there were also likely some new enrollees,” said Louise Norris, a health policy analyst at healthinsurance.org, an insurance information website.
Norris said there could be a large upswing in enrollment ahead of Monday’s deadline for coverage starting Jan. 1. “Then again you’ll see another sort of surge as we get to mid-January” — the Jan. 15 deadline for coverage starting Feb. 1, Norris said.
Both Norris and Brooks-LaSure said that initial enrollment numbers also don’t tell the whole story.
“The people who are enrolling right now are people who absolutely know they need to have coverage,” Brooks-LaSure said. “But the number always drops when people have to pay their premiums. And so, it’s really the number in January, once people are enrolled, that we think that will be the important number to know about coverage.”
People who are not changing plans may be automatically renewed in their current plans, which can explain some of the initial signups, said Brooks-LaSure. In addition, she said, some people signing up may be opting for less expensive — but also less generous — health insurance than they purchased in the past.
HealthCare.gov classifies health plans as Gold, Silver or Bronze. Gold plans have costlier premiums but more generous coverage with lower deductibles and less cost-sharing required of patients. Bronze plans have lower premiums with higher deductibles and more cost-sharing, and Silver plans are in between.
Brooks-LaSure said she has heard anecdotally from people stepping down from Silver to Bronze plans, for example.
“Coverage is really important, of course, but your ability to actually pay when you go to the doctor is equally, if not more, important,” she said. “It may be that we don’t see the drop in the uninsured rate. We see people shifting to less generous coverage.”
Kelley Bruns, a Sawyer County resident who spoke on Baldwin’s call, said she and her husband took that route for 2026.
Bruns said her husband, a veteran and career firefighter, had to end his career early due to work injuries and resulting disabilities.
When the premium for the policy they had in 2025 rose to more than $1,600 a month — 40% of their monthly income — they opted for a less expensive plan for 2026. That plan, however, has copayments of up to $100, a $15,000 deductible and a cap on out-of-pocket expenses of more than $21,000.
“We have to pray we don’t need surgery or any other major medical procedure,” Bruns said, “since our out-of-pocket maximum is almost half of our annual income and would be a catastrophic expense for our family.”
The Covering Wisconsin webpage. The nonprofit, housed at the University of Wisconsin Extension, is a navigator agency to help people understand their options when buying health insurance through the HealthCare.gov marketplace. (Screenshot)
About 4,000 fewer people in Wisconsin signed up at the federal HealthCare.gov marketplace in November for a health plan for next year than did in November 2024 for coverage this year, recently released numbers from the federal government show.
It’s too soon to tell for sure whether that will forecast a significant drop in health coverage through the marketplace, according to William Parke-Sutherland of the Wisconsin family policy research and advocacy group Kids Forward.
Parke-Sutherland and others who pay close attention to health care access in Wisconsin are watching those numbers closely, however.
Monday, Dec. 15, marks a critical deadline — the last day that people who purchase a health plan through the marketplace can sign up for coverage that starts Jan. 1, 2026.
The Healthcare.gov marketplace was created as part of the Affordable Care Act. Enacted in 2010 to drive down the ranks of Americans without access to health care, the ACA established the marketplace to make it easier and cheaper for people without coverage from an employer or through government programs such as Medicaid to buy health insurance.
Enhanced tax credit subsidies first enacted in 2021 on health plans sold through the marketplace have helped boost enrollment to new records over the last four years nationally and in Wisconsin. More than 300,000 state residents received their health coverage for 2025 through the marketplace.
Those enhanced subsidies expire at the end of this year, however, leading to forecasts that enrollment will decline in 2026 as the cost of insurance climbs.
“Many Wisconsinites will see their premiums double, and some will see staggering increases of over $30,000 a year,” Gov. Tony Evers said Wednesday during a press call with the ACA advocacy groups Protect Our Care and Main Street Alliance. “That’s ridiculous and unattainable for many.”
The event was held both to alert people about Monday’s open enrollment deadline and to urge voters to lobby Congress to extend the subsidies.
“Each year, the Affordable Care Act and open enrollment has ensured hundreds of thousands of Wisconsinites having life-saving health care coverage,” Evers said. “These tax credits are not luxuries — they are lifelines that make the difference between kids and families and communities getting care or going without it.”
This year, 88% of Wisconsin residents who enrolled at HealthCare.gov qualified for the enhanced subsidies and saved $644 a month on average, Evers said.
Thad Schumacher, a Fitchburg pharmacist who also joined the call, said losing coverage would lead people to forgo “their primary care visits, their medications, for chronic conditions like diabetes and hypertension, and preventative care that keeps people healthy.”
Early numbers send mixed signals
The federal Centers for Medicare & Medicaid reported that from Nov. 1 to 29 this year, 84,398 Wisconsinites enrolled in coverage through the marketplace. From Nov. 1 to Nov. 30, 2024, Dairy State enrollment totaled 88,189, according to CMS.
Nationally numbers are up, however — 5.76 million in November this year, compared with 5.36 million in November last year, according to CMS.
While Wisconsin’s decrease of less than 4,000 people signing up may look small, “It’s just hard to know what this means,” Parke-Sutherland told the Wisconsin Examiner.
In the years going back to 2022, the first month of open enrollment saw anywhere from 29% to 42% of that year’s total HealthCare.gov sign-ups, he said.
At Covering Wisconsin — a federally licensed navigator that helps guide people through the process of enrolling in HealthCare.gov plans — the volume of November calls and contacts through the navigator’s web-based chat portal have been about even with the same month last year, said Allison Espeseth, the Covering Wisconsin director.
In 2024, however, there was “a pretty big spike” in contacts in the first two weeks of December leading up to the Dec. 15 deadline for coverage to start Jan. 1.
“This year, we are definitely continuing to have people call us, but we haven’t seen that spike,” Espeseth said.
She offered several possible reasons for that. Some people may have seen higher premiums for their plans and decided to go without. Others may think that there won’t be any subsidies, despite the fact that smaller subsidies that were part of HealthCare.gov plans from the beginning remain in place.
And some have wondered whether they should hold off on signing up in case Congress does reach a deal and extend the subsidies, Espeseth noted.
“We’ve been encouraging people to please sign up regardless,” Espeseth said. “Don’t wait.”
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