A July report from Wakely shows that as of April, the number of ACA Marketplace enrollees with at least one hierarchical illness code increased by 6.3% compared to last year. This trend is seen in both federal and state exchanges.
Silver-tier plans had a 15.8% increase in enrollees with at least one hierarchical illness code compared to last year. This may mean that healthier, lower-income people are switching to Bronze or Gold plans instead of cost-sharing plans.
The report also shows a 12% drop in ACA Marketplace enrollment during the first four months of 2026, while the share of enrollees with claims rose just 0.2%. The share of claims from enrollees with at least one hierarchical condition went up by 0.6%, which shows that sicker enrollees are using more services.
The report also says risk scores will likely rise as the year goes on, since ACA enrollees switch plans and new claims are processed with some delay at their new 2026 insurer. As new codes are added to the insurer’s system, enrollees’ reported morbidity will rise over the year.
The Wakely report supports the idea that healthier people who cannot afford higher cost-sharing or premiums are leaving the ACA Marketplace. These former ACA clients need other, more cost-effective health coverage options for financial protection.
Catastrophic, indemnity, and new ACA-alternative policies are other options for coverage these healthier, low-income former ACA enrollees to consider. This leaves more people with health challenges in these plans, as they need coverage to treat their illnesses.
This trend is also reflected in the proposed 2027 monthly plan premiums from ACA Marketplace insurers.
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