Why 95% of Marketplace Enrollees Are Excluded

Approximately 95% of marketplace enrollees—roughly 18 million of the nation’s 19.2 million Affordable Care Act customers—are excluded from this program.

Most enrollees receive income-based premium tax credits, which the government considers substantial financial assistance. Relief targets only those paying entirely out of pocket.

Millions buying directly from private insurers off-exchange are also ineligible. If your monthly invoice reflects an “Advance Premium Tax Credit,” you will not receive this check.

Understanding the HealthCare.gov User Fee Refund and Funding Surplus

This payout is an administrative fee rebate funded by exchange operations. HealthCare.gov charges insurers a user fee, which is passed directly to policyholders through premiums.

For 2026, this federal fee was 2.5% of total premiums. A KFF analysis revealed that significant surplus funds accumulated from these fees between fiscal years 2018 and 2020.

The White House used that accumulated surplus to finance this healthcare.gov user fee refund. For 2027, the Centers for Medicare & Medicaid Services (CMS) lowered the rate to 1.9%.