Affordable Care Act Marketplace Enrollment Shifts in Rural Areas: Implications of Shift to Bronze Plans

The Centers for Medicare and Medicaid Services (CMS) released an interim report in March 2026 giving a great deal more information about the plans chosen by people who signed up for the Affordable Care Act (ACA) marketplace, sometimes called “Obamacare” plans. Initial enrollment dropped significantly in 2026, compared to 2025. The drop in signups is happening in part because recipients are facing significant increases in marketplace premiums, resulting from a decision made by the Congress not to renew the enhanced premium tax credits (EPTCs) at the end of 2025. Preliminary analysis of the data on types of plans chosen by recipients (differentiated by their metal level) shifted, mostly from silver to bronze plans. This shift in plan choices is important because bronze plans tend to have higher deductibles and copayments, leaving customers to face higher out of pocket costs should they access medical care. The changes in enrollment and plan choices is differentially affecting those living in rural and urban areas, according to the latest data reported by CMS. In this project, RUPRI will explore the shifts in enrollment and consider the implications of these changes for rural people, places, and providers.