Open Enrollment remains one of the most important moments on a payer’s calendar. For health plans with an individual marketplace presence, the 2026 Open Enrollment Period brings a more complex operating environment: Marketplace plan selections declined from the 2025 record high,1,2 affordability pressure increased for many consumers,4 and members continue to expect simple, secure digital premium payment experiences.6 As payers evaluate acquisition, retention and member engagement strategies, recent data can help frame where the enrollment opportunity is shifting and why the premium experience matters.
Every year, open enrollment is an annual period in the healthcare industry where consumers can enroll in a new health plan or make changes to an existing plan. This happens across all lines of payer business from employer-sponsored plans to the individual marketplace. The significance of Open Enrollment for payers cannot be understated.
During Open Enrollment, there are opportunities for payers to attract new enrollees, as well as a need to retain current members. Ultimately, a successful open enrollment period can increase membership enrollments, demonstrate how loyal members are, and potentially improve the financial stability of a payer’s bottom-line.
The individual marketplace continues to represent a meaningful opportunity for payers, but the dynamics heading into 2026 are different from prior years. After several years of record Marketplace growth, 2026 plan selections declined and affordability became a more prominent factor in whether consumers selected, paid for and maintained coverage.
In this blog, payers can find eight updated data points that demonstrate the 2026 Open Enrollment landscape and how premium payment experiences can play a pivotal role in acquisition, retention and member satisfaction.
1. 23 million consumers selected Marketplace coverage for 2026, down from 24.2 million in 2025.1,2
Marketplace enrollment remains large, but 2026 plan selections declined by roughly 1.2 million from the prior year. For payers, that means Open Enrollment is still a major growth and retention opportunity, but member acquisition may require sharper segmentation, clearer communication and a lower-friction path from plan selection to first premium payment.
For 2026 coverage, the federal Marketplace Open Enrollment Period ran from November 1, 2025 through January 15, 2026 in HealthCare.gov states, with coverage effective January 1 for consumers who selected a plan by December 15 and February 1 for later selections.3
2. 3.4 million consumers were new to the Marketplaces for 2026.1
While the Medicaid redetermination surge has moved out of the immediate 2023 environment, new consumer activity remains significant. CMS reported 3.4 million new Marketplace consumers for 2026 and 19.6 million returning consumers.1 For payers, this creates a dual challenge during Open Enrollment: make it easy for new members to complete enrollment and make their first payment, while giving returning members a seamless renewal and premium payment experience.
3. Average monthly premium payments increased by 58% in 2026 among ACA Marketplace consumers studied by KFF.4
Affordability was a defining issue for the 2026 enrollment cycle. KFF found that average monthly premium payments increased from $113 to $178 after enhanced Marketplace premium tax credits expired at the end of 2025.4 For payers, higher consumer cost sensitivity can make payment flexibility, clear billing communication and convenient digital options more important to retaining members after plan selection.
4. Average ACA Marketplace deductibles increased 37% in 2026, reaching a record-high $3,786.4
KFF reported that deductibles rose by $1,027 per person in 2026, reflecting a shift toward higher-deductible plans as consumers looked for lower monthly premiums. This is an important signal for payers: when members face higher out-of-pocket exposure, every payment interaction can affect their perception of affordability, trust and value.
5. 14% of consumers in one 2026 analysis did not pay their January premium.5
Plan selection is only one step in the enrollment journey. Coverage generally depends on the member paying the first month’s premium. A 2026 analysis cited by Healthcare Finance News reported that an estimated 14% of consumers did not pay their January premium. For payers, this reinforces the importance of fast, intuitive binder payment experiences that help convert plan selections into active, paid coverage.
6. 71% of payers reported calls due to member confusion and payment questions as a top challenge.6
This payer-reported challenge remains relevant for 2026 because affordability pressure, plan switching and enrollment timing can all increase member questions. Call volume is often a sign that existing digital tools and payment channels are not fully meeting member needs. Reducing confusion through clear communications, digital billing and self-service payment options can help improve the member experience during a high-stakes enrollment period.
7. 93% of individual members want to pay premiums electronically, and 81% want to pay online.6
Member preference for electronic and online premium payments continues to be highly relevant as consumers manage larger premium obligations and compare coverage options. Online payments can help reduce reliance on paper, mail and call center support while giving members more control over how and when they pay.
8. 68% of individual members want to schedule automatic deductions for recurring premiums.6
If a member misses a premium payment, coverage can be disrupted. For many payers, premium collections remain a retention issue as well as an operational challenge. Automated recurring payments can help members avoid missed payments, reduce administrative follow-up and support a more predictable premium collection process. In a 2026 environment where affordability and payment completion are more closely connected to coverage retention, recurring payment options can be an important part of the member experience strategy.
1CMS, Marketplace 2026 Open Enrollment Period Report: National Snapshot, January 28, 2026.
2CMS, Marketplace 2025 Open Enrollment Period Report: National Snapshot, January 17, 2025.
3CMS, Marketplace 2026 Open Enrollment Fact Sheet, November 3, 2025.
4KFF, What We Know So Far About 2026 ACA Marketplace Enrollment, Premiums, and Deductibles, May 19, 2026.
5Healthcare Finance News, ACA marketplace enrollment losses deepen, June 10, 2026.
68 Stats for Payers to Prepare for Open Enrollment