ACA Enrollment Dropped by 1.4 Million — But Coverage Options Still Exist
ACA health insurance enrollment dropped by approximately 1.4 million people in the most recent open enrollment period, according to reporting from Business Insider, with some states experiencing far steeper declines than others. If you're among those who didn't enroll — or if you lost coverage and aren't sure what comes next — there are still programs that may be available to help you access healthcare. The path forward depends on your income, household size, state of residence, and whether you've experienced a qualifying life event.
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Why Enrollment Fell — and Why It Matters for You
The enrollment decline reflects a combination of factors: the end of pandemic-era continuous Medicaid enrollment protections (which triggered a nationwide "unwinding" process that removed millions from Medicaid rolls), administrative barriers, and uncertainty around the future of enhanced premium tax credits. States that saw the largest drops tended to have higher rates of Medicaid disenrollment and lower outreach infrastructure.
For individuals and families trying to navigate this, the practical consequence is the same: more people are uninsured or underinsured heading into 2025 and 2026. That creates real risk — medical debt, delayed care, and worsened health outcomes. But it also means it's worth taking a careful look at every program that may still be accessible to you.
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If You Missed Open Enrollment: Special Enrollment Periods (SEPs)
The ACA Marketplace's standard open enrollment period typically runs from November 1 through January 15 in most states (dates vary for state-run exchanges). If that window has passed, you may still be able to enroll through a Special Enrollment Period (SEP) if you've experienced a qualifying life event within the past 60 days.
Qualifying Life Events That Trigger an SEP
- Loss of job-based coverage (including COBRA expiration)
- Marriage or divorce
- Birth or adoption of a child
- Moving to a new coverage area
- Gaining citizenship or lawful presence
- Release from incarceration
- Income change that affects your subsidy eligibility
If you qualify for a SEP, you can enroll through HealthCare.gov (for the 34 states using the federal platform) or your state's own exchange. You'll typically have 60 days from the qualifying event to enroll.
Documents you'll likely need: - Proof of the qualifying event (termination letter, birth certificate, marriage license, etc.) - Social Security numbers for all household members applying - Proof of income (recent pay stubs, tax returns, or a self-attestation form) - Immigration documentation if applicable
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Medicaid: The Largest Safety Net for Low-Income Adults
If your income is at or below 138% of the Federal Poverty Level (FPL) and you live in one of the 41 states (including Washington, D.C.) that have expanded Medicaid under the ACA, you may be eligible for Medicaid — the joint federal-state health insurance program for low-income individuals and families. Benefit amounts vary by household size and income, and coverage details differ by state.
In the 10 states that have not expanded Medicaid, eligibility thresholds are significantly lower and often exclude non-disabled adults without dependent children. If you're in a non-expansion state and your income falls in the gap between your state's Medicaid limit and 100% FPL, you may face limited options — but community health centers (discussed below) remain available.
How to Apply for Medicaid
- Visit your state Medicaid agency directly or apply through HealthCare.gov, which screens for Medicaid eligibility automatically.
- Applications can also be submitted in person at your local Department of Social Services or equivalent agency.
- Medicaid has no open enrollment period — you can apply at any time of year.
- Eligibility decisions are typically made within 45 days (90 days for disability-based applications).
Required documents typically include: - Proof of identity (driver's license, passport, or state ID) - Proof of residency (utility bill, lease agreement) - Proof of income (pay stubs, employer letter, or tax documents) - Social Security number - Immigration status documentation if applicable
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CHIP: Coverage for Children When Parents Don't Qualify
The Children's Health Insurance Program (CHIP) covers uninsured children in families whose income is too high for Medicaid but who cannot afford private insurance. In most states, CHIP covers children in households earning up to 200% FPL, and many states extend coverage to 300% FPL or higher.
Like Medicaid, CHIP has no open enrollment window — families can apply year-round. Pregnant women may also be eligible for CHIP-funded prenatal care in some states, even if they don't otherwise qualify for Medicaid.
To find your state's CHIP program and income thresholds, visit InsureKidsNow.gov or apply through your state Medicaid agency.
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ACA Premium Tax Credits: What's Still Available
For those who do enroll through the Marketplace, premium tax credits (PTCs) — also called Advanced Premium Tax Credits (APTCs) — can significantly reduce monthly premiums. Enhanced subsidies introduced under the American Rescue Plan Act (ARPA) and extended through the Inflation Reduction Act are currently available through the end of 2025.
Under current law, households earning between 100% and 400% FPL have long been eligible for PTCs. The enhanced subsidies extended meaningful assistance to households above 400% FPL as well, capping premium costs as a percentage of income. Whether these enhanced credits will be renewed beyond 2025 is subject to Congressional action — a policy development worth monitoring closely if your coverage depends on them.
If your income is below 100% FPL and you live in a non-Medicaid expansion state, you may fall into a coverage gap where neither Medicaid nor Marketplace subsidies are accessible. In that situation, the options below become especially important.
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Federally Qualified Health Centers: Care Regardless of Insurance Status
Federally Qualified Health Centers (FQHCs) — also called community health centers — are federally funded clinics that provide primary care, dental, mental health, and substance use services on a sliding-fee scale based on income. They are required by law to serve patients regardless of their ability to pay or insurance status.
There are more than 1,400 FQHC organizations operating over 15,000 service delivery sites across all 50 states, Washington, D.C., and U.S. territories. For uninsured individuals who don't qualify for Medicaid and can't afford Marketplace premiums, FQHCs are often the most accessible entry point into the healthcare system.
To find the nearest FQHC, use the Health Resources and Services Administration (HRSA) Find a Health Center tool at findahealthcenter.hrsa.gov.
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Prescription Assistance Programs
If you're uninsured or underinsured and struggling with medication costs, several programs may help:
- Medicare Extra Help (Low Income Subsidy): For Medicare beneficiaries with limited income and resources, this program may help cover Part D prescription costs.
- Pharmaceutical Manufacturer Patient Assistance Programs (PAPs): Most major drug manufacturers offer free or reduced-cost medications to qualifying low-income patients. NeedyMeds.org and RxAssist.org maintain searchable databases.
- State Pharmaceutical Assistance Programs (SPAPs): Some states operate their own prescription drug assistance programs for residents who don't qualify for federal programs.
- 340B Drug Pricing Program: FQHCs and certain other safety-net providers participate in this federal program, which allows them to purchase drugs at significantly reduced prices and pass savings to patients.
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What to Do Right Now: A Practical Checklist
- Check Medicaid eligibility first — it's year-round, and the income threshold covers a large portion of uninsured adults in expansion states.
- Review whether you've had a qualifying life event in the past 60 days that opens a Special Enrollment Period.
- Locate your nearest FQHC at findahealthcenter.hrsa.gov for immediate care needs.
- Gather your documents before starting any application: proof of identity, income, residency, and household composition.
- Contact a certified Navigator or enrollment assister — these are federally funded, free helpers who can walk you through Marketplace and Medicaid applications without any sales pressure. Find one at LocalHelp.HealthCare.gov.
If you submit any form requesting information about available programs, note that by doing so you may be consenting to be contacted by program representatives or outreach staff. Review any consent language carefully before submitting.
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Program eligibility and availability vary by state. Not affiliated with any government agency.
Last reviewed: May 2026