EXCLUSIVE! FINAL 2026 Open Enrollment Report published: 23.1M QHP selections; 25.0M w/BHPs, down 1.2M y/y (Part 1)

Fri, 03/27/2026 - 2:29pm

When I last checked in on the official 2026 ACA Open Enrollment Period (OEP) data from the Centers for Medicare & Medicaid Services (CMS), they had published the "top line" enrollment numbers for each state, including final numbers for the 30 states hosted via the federal ACA exchange (HealthCare.Gov) and semi-final data for the remaining 20 states (+DC) which operate their own ACA exchanges.

I've repeatedly warned that the final, official CMS 2026 OEP report--which includes far more detailed demographic data including breakouts by metal level, income brackets, financial assistance and so forth likely wouldn't be published until late April or early May based on last year when it wasn't published until May 11th.

Well, it turns out they moved that up substantially after all: The final 2026 OEP Public Use File was just uploaded at CMS today...and while there hasn't been any formal press release published yet, I have a copy regardless.

With that in mind, let's dig in!

Note before I start: While it's always possible that the Musk/Trump Regime has manipulated the data (as I warned last year), a cursory look at the top-line numbers suggests that it seems to be accurate.

The table below has the data for both Qualified Health Plans (QHPs) in all 50 states + DC as well as Basic Health Plan (BHP) enrollment in the District of Columbia, Minnesota, New York, Oregon only, compared to the 2025 OEP.

I've also grouped the data by type of ACA exchange (federally facilitated or state-based) and by Medicaid expansion status. The main takeaways are pretty much the same as I've written about earlier this year, with some slight modifications as the final numbers have come in:

Overall QHP enrollment is down 4.9%% y/y (-1.19M)
Overall BHP enrollment is up 6.4% y/y (+113K)
(this is partly due to DC newly launching their BHP program this year)
Federal exchange enrollment is down 5.4% y/y (-891K)
State-based exchange enrollment is down 3.9% y/y (-297K) without BHPs
(The SBE reduction is only -197K with BHPs included)

The grand total of QHPs + BHPs combined is 24,998,778 people...which is 1,075,757 lower than last year.

Since Medicaid expansion "cannibalizes" a large chunk of enrollees who'd otherwise be eligible for QHPs (similar to how BHPs do), that's another important factor:

EXPANSION state enrollment is down 7.1% y/y
NON-expansion state enrollment is down 2.9% y/y

Some key state numbers:

While most states saw enrollment drop (dramatically in many cases), NEW MEXICO saw a whopping 18.1% increase thanks largely to their state-based subsidies which fully backfilled the lost federal tax credits for 100% of all enrollees!

9 other states saw more modest enrollment increases ranging from 1.0 - 7.5% (PA, LA, ID, RI, MD, CT, MA, TX & DC).

Highest y/y QHP increase by raw number: TEXAS, which saw total enrollment go up by over 200,000 people in spite of the tax credits expiring (thanks largely to their robust Premium Alignment policy, I'm assuming).

The other 9 states with y/y increases were far more modest, ranging from 1,100 in DC to 14,000 in Massachusetts.

At the opposite end:

The remaining 41 states all saw net drops in QHP enrollment year over year, of course:

NORTH CAROLINA had the most dramatic drop, of nearly 22% since OEP 2025...over 213,000 NC residents lost coverage out of the gate. This is also the highest raw number of ACA exchange enrollees any state lost this year.

Other states with double-digit drops include OH, WV, IN, DE, AZ, OR, OK, GA, MO, TN, WY & IA

Every other state lost between 0.8 - 9.5% of their initial plan selections.

Florida once again has by far the highest percent of its total statewide population enrolled in ACA exchange QHPs: 19.3%, or 1 out of every 5 Floridians. Part of this is due to them not expanding Medicaid, but no other non-expansion state has more than 13.2% of their populations enrolled in exchange plans.

At the opposite end (not including BHP states) is Hawaii: Just 1.6% of its total population is enrolled in an on-exchange QHP.