CMS Releases Rules for 2026 Marketplace Plans

The Centers for Medicare and Medicaid Services (CMS) has published proposed rules to support the 2026 Notice of Benefit and Payment and the Basic Health Program for the Health Insurance Marketplace authorized under the Patient Protection and Affordable Care Act.  CMS also released a Payment Notice Fact Sheet and a Draft Letter to Issuers. The comment period for the 2026 proposed rule will close on November 12, 2024. You can access each document at the following links:  

• Payment Notice Proposed Rule: https://www.federalregister.gov/documents/2024/10/10/2024-23103/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2026-and
• Payment Notice Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/hhs-notice-benefit-and-payment-parameters-2026-proposed-rule
• Draft Letter to Issuers:  https://www.cms.gov/files/document/2026-draft-letter-issuers-federally-facilitated-exchanges.pdf

The rule proposes the standards for the Health Insurance Marketplaces, as well as for health insurance issuers, brokers, and agents who connect millions of consumers to ACA coverage. Policies included in the proposed rule are intended to reduce administrative burden, ensure accurate risk adjustment transfers, promote transparency, and enhance health equity in the marketplace. Key updates in the proposed rule include:

• Additional safeguards, beginning in 2025, to protect consumers from fraudulent changes to their health care coverage, as well as options to ensure the integrity of the Federally Facilitated Marketplace (FFM).
• Changes that make it easier for consumers to understand their costs and enroll in coverage through HealthCare.gov beginning in plan year 2026.
• Updates to the HHS risk adjustment program (the permanent program that transfers funds from issuers of risk adjustment covered plans with lower-than-average risk to issuers of risk adjustment covered plans with higher-than-average risk; risk adjustment covered plans include the individual, small group markets, or merged markets, inside and outside the Marketplaces).
• 2026 user fee rates for issuers.
• Changes to calculations for the Basic Health Program (BHP)
• Annual public reporting of aggregated, summary-level information from the ACA Quality Improvement Strategy (QIS), a program that aims to incentivize improved health outcomes for plan enrollees.

The proposed 2026 Payment Notice comment period closes on November 12, 2024, At the Federal Register.