The Centers for Medicare & Medicaid Services has proposed sweeping changes in the health plans offered by Affordable Care Act marketplace exchanges.
The changes, revealed in CMS’s proposed Notice of Benefit and Payment Parameters for 2027, affect both the regulations governing the types of health plans that can be offered on exchanges and how potential buyers of those plans are deemed eligible for those plans. The major changes include:
Permitting insurers to offer catastrophic plans with terms of either one year or multiple consecutive years, up to ten years.- Repealing standardized plan options and related limit requirements.
- Permitting low-deductible plans with higher maximum out-of-pocket limits.
- Better aligning affordability and coverage incentives across catastrophic and metal-level plans.
- Expanding hardship exemptions for certain individuals age 30 and older in all states.
- Permitting network plans to receive Qualified Health Plan certification by demonstrating sufficient provider choice.
- Implementing stronger eligibility and income verification and enhanced enforcement policies to ensure that premium subsidies are reserved for eligible individuals and updating of exchange policies to reflect new legal requirements that limit eligibility for premium tax credits, cost-sharing reductions, and advance payments of those benefits to individuals who meet immigration eligibility standards.
- Strengthening standards of conduct for insurance agents, brokers, and web brokers by clarifying prohibited marketing practices and reinforcing oversight to deter fraud and misleading conduct.
- Regulating Essential Health Benefits to ensure that federal subsidies are not used to finance state-mandated benefits.
- Modernizing network adequacy and provider access reviews.
Learn more about the proposed rule, including the underlying rationale for these changes, from this CMS news release; an accompanying fact sheet; the proposed rule itself; and the Healthcare Dive article “CMS proposes sweeping ACA exchange rule.”
