CMS data shows 5.8M Americans enrolled in ACA coverage in November—more than last year

By Chad Van Alstin / December 10, 2025

The Centers for Medicare & Medicaid Services (CMS) has released data from November on open enrollment signups on government-run medical insurance marketplaces, both state and federal. With nearly 5.8 million people enrolling as of Nov. 29, the number of people getting their health coverage through the Affordable Care Act (ACA) is trending slightly higher than last year.

When comparing statistics from November 2024 with those released this week, an additional 400,000 people have entered the program this year so far, despite the expiration of enhanced subsidies that made medical coverage more affordable. 

As of now, 4.8 million of those buying coverage were returning enrollees from last year, with roughly 950,000 new individuals and families signing up. Breaking down the data, CMS said the vast majority (4.6 million) used HealthCare.gov for insurance, while roughly 1.2 million people relied on state-run brokerage markets. 

Notably, 30 states use the federal exchange as their primary distribution platform, while the remaining 20 run their own websites. 

Open enrollment ends on Dec. 15, with new coverage to kick in on January 1, 2026. The overall enrollment figures are still unknown, as data from December won’t be released until after the deadline. 

Devil in the details

The specifics on what types of coverage people are buying will matter as much as the overall numbers. As reported previously by HealthExec, CMS said last year that it would be cracking down on gray market, low-value insurance coverage being offered by brokers on ACA exchanges. Yet, these plans are still showing up in searches, offering enticing low premiums that may not result in medical bills being paid as expected.

Further, price hikes as a result of expired subsidies may push more Americans to high-deductible bronze plans, used primarily for emergencies. This would leave potentially millions underinsured. 

The enhanced subsidies were put in place during the COVID-19 pandemic, but heading into 2026 have been allowed to lapse. Any attempts in Congress to restore them have failed up to this point, including a record-setting shutdown of the federal government over the issue.

This is a developing story, and we’re unlikely to have a full picture of American medical coverage until at least early 2026.