New ACA Strategies: What Health Insurers Can Learn From the 2026 Marketplace
The 2026 Affordable Care Act (ACA) marketplace has changed the health insurance consumer journey.
Now that enhanced ACA premium tax credits have expired, many consumers face higher health insurance premiums and more complicated choices. Insurers and state-based exchanges now face a tougher marketing challenge: They have to attract consumers, retain members, and help people make informed decisions in a more complex health insurance market.
State ACA exchanges must adopt a new approach to enrollment marketing and the lessons also apply to commercial health insurers, which can learn from consumer responses to higher costs, greater plan complexity, and a fragmented health insurance information environment.
How can you communicate effectively in this environment?
Here are seven strategies health insurers and ACA exchanges should consider for the upcoming 2026–2027 enrollment cycle.
1. Help consumers navigate affordability and “sticker shock”
The enhanced ACA premium tax credits for individuals and families expired at the end of 2025. While the basic ACA premium tax credit remains available (and some states have provided additional assistance), many households receive less financial help. Some above 400% of the federal poverty level are no longer eligible for premium tax credits. The result is a more difficult affordability conversation.
Marketplace enrollment fell from 21.8 million in 2025 to 19.2 million in 2026, a 12% decline. The Kaiser Family Foundation (KFF) found state-based exchanges generally performed better than states using the federal HealthCare.gov platform, especially those that supplemented federal financial assistance.
The Congressional Budget Office (CBO) has also projected that expiration of the enhanced tax credits could disproportionately encourage healthier consumers to leave the Marketplace, potentially putting additional upward pressure on premiums. Despite all these challenges, our client Access Health CT (AHCT) saw record enrollment during the last open enrollment.
For consumers, the fundamental question is now: “How can I afford health insurance with these cost changes?” Health insurance companies and exchanges must answer this clearly and directly. AHCT’s solution was to increase outreach and expand enrollment events to address these questions.
2. Make health insurance decisions easier
Premiums are only part of the problem. Consumers are also facing greater complexity when comparing health plans and evaluating the total cost of care.
Depending on their circumstances, they need to evaluate
- plan type and benefits
- deductibles, copayments, and coinsurance
- out-of-pocket maximums
- provider networks
- prescription drug formularies
KFF reports that average Marketplace deductibles increased by approximately $1,000 per person in 2026 as more consumers are selecting higher-deductible plans to offset premiums.
This creates a major communications challenge. Consumers don’t need more information; they need help understanding what the changing cost picture means specifically for them. This distinction should shape how insurers and exchanges approach content, advertising, websites, search, and enrollment tools.
3. Rethink audience segmentation
Traditional health insurance marketing efforts divide audiences into broad categories like prospects and existing members. The current environment requires more granular segmentation because consumers face very different financial and coverage situations.
For ACA exchanges, important audiences include
- new Marketplace prospects who have never enrolled
- satisfied existing members who may be inclined to renew automatically
- existing members who face significant premium increases
- consumers who dropped Marketplace coverage in 2026
- people who lost Medicaid or CHIP coverage and may now qualify for Marketplace coverage
Each audience has different questions, barriers, and reasons to act. A person who has never enrolled may need basic education. Someone facing a major premium increase needs to understand alternative plan options. Someone who lost Medicaid may need to know affordable Marketplace coverage could still be available. An existing member may need to hear something very different, like “Don’t assume your current health insurance plan is still your best option.”
Segmenting by consumer need, not simply demographic characteristics, can create more relevant journeys and more effective marketing.
4. Prioritize retention and re-shopping
For years, Marketplace marketing has emphasized acquisition: Get eligible consumers to enroll. The 2026 environment creates a much larger retention challenge.
Consumers who enrolled in 2025 may return to the Marketplace and find their premium has increased significantly. That may cause some to consider going uninsured, especially younger, healthier consumers who see themselves as less likely to need medical care.
At the same time, “keep your plan” may no longer be the best advice for every member. Perhaps a better message is “Don’t just renew. Re-shop.” or “Why coverage is worth it.”
Health insurance exchanges should encourage consumers to return, update their information, and actively compare coverage options before automatic renewal. Our exchange clients began emphasizing this message when the Medicaid eligibility redetermination process started two years ago.
This creates an opportunity to redefine the exchange’s role from an enrollment portal to a trusted health insurance decision-making service.
That lesson also applies to commercial insurers. Retention rates depend more on helping members understand their coverage’s value than simply reminding them to renew.
5. Make brokers an extension of your marketing strategy
Brokers and agents play a key role in helping consumers navigate health insurance decisions. Brokers are more than a distribution channel; they are also an important education and communications channel.
Exchanges and insurers can support brokers with
- simple explanations of subsidy changes
- plan comparison tools
- multilingual educational materials
- social media content
- email templates
- enrollment deadline communications
The more complicated the consumer’s decision becomes, the more important it is to equip every person who influences that decision with clear, consistent information. Exchanges and insurers should increase awareness of all available resources, including brokers, to simplify decision making.
6. Become the trusted answer in search and AI
Health insurance consumers increasingly encounter information through a fragmented ecosystem that includes
- health insurer websites and advertising
- broker websites
- lead-generation sites
- search engines
- AI-generated answers
- social media
- political commentary
- outdated articles
- misleading “free health insurance” claims
This creates a new competitive challenge. Insurers and exchanges are no longer competing only for enrollment. They are competing to become the source consumers trust when they have a question. Consider the questions “How much will health insurance cost me?” and “Can I still get financial help paying for health insurance?”
Those are search questions and, increasingly, AI questions. Organizations that provide the clearest, most authoritative answers can influence consumers before they reach an enrollment page. That means health insurance enrollment marketing strategies should incorporate AI search optimization, search engine optimization, structured content, and consumer-focused educational resources alongside traditional paid media.
The goal is not simply to rank for “health insurance,” but to become the answer when consumers ask the questions that determine whether and how they buy coverage.
7. Communicate earlier
The Centers for Medicare and Medicaid Services has designs on a more compressed enrollment period, including requirements governing when enrollment can begin and end. For state-based health insurance marketplaces, a limited enrollment window would leave less time to educate consumers before they need to act. That makes early communication more important.
Rather than waiting until open enrollment begins, exchanges and insurers should consider a staged communications strategy. The objective is to move from a short enrollment campaign to an always-on consumer education strategy.
A new role for the health insurance brand
These changes point to a larger strategic shift. Historically, an ACA exchange was primarily a portal to search for and enroll in health coverage. But the consumer problem in 2026 is more complicated:
“Help me make a good health insurance decision in a confusing and expensive market.”
Now, an exchange’s competitive advantage may not simply be access to subsidies or a marketplace of plans. Its greatest value may be its ability to reduce uncertainty and help consumers make sense of their choices.
That creates powerful territory for content, creative, and digital experiences.
What can health insurers learn from ACA exchanges?
The changes facing ACA exchanges preview a broader challenge for the health insurance industry. Consumers are being asked to make increasingly consequential financial and healthcare decisions while navigating higher costs, more complicated plan designs. and an overwhelming amount of information.
The organizations that succeed will not simply provide more information. They will make health insurance coverage easier to understand, compare, and act on. ACA exchanges must move from enrollment marketing toward consumer decision support. Commercial insurers must recognize that the same consumer expectations are emerging across the entire health insurance market.
The future of health insurance marketing
At RDW, we help health insurance exchanges and insurers develop marketing, content, and digital strategies that respond to changing consumer behavior. Contact us to learn how we can help your organization turn complexity into a competitive advantage.
