HHS Notice of Benefit & Payment Parameters for 2026 Final Rule

The Department of Health and Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) issued the final HHS Notice of Benefit and Payment Parameters for 2026. The rule sets standards for the Health Insurance Marketplaces, as well as for health insurance issuers, brokers, and agents who connect millions of consumers to ACA coverage. The rule finalizes additional safeguards, beginning in 2026, to protect consumers from unauthorized changes to their health care coverage. The final 2026 Payment Notice is effective January 15, 2025. 

Preventing Unauthorized Marketplace Activity Among Agents and Brokers

Strengthening Reviews and Enforcement Actions, When Needed: CMS is finalizing a policy that enables it to take enforcement actions against lead agents at insurance agencies to hold them responsible for violations of Marketplace standards when appropriate. This policy will enhance public trust in the Marketplace, increase accountability for agents, brokers, and web-brokers who assist consumers, and reduce the risk of fraud or misconduct that puts consumers’ health care coverage at risk.

Expanding Authority to Immediately Suspend Marketplace Agents and Brokers: Currently, if CMS determines that an agent or broker poses an unacceptable risk to Marketplace operations or Marketplace information technology systems, we will use our existing authority to immediately suspend that agent or broker’s ability to transact information with the Marketplace until the incident or breach is remedied or sufficiently mitigated to CMS’ satisfaction. In this rule, CMS is finalizing a policy to expand its authority to immediately suspend an agent or broker’s ability to transact information with the Marketplace if we discover circumstances that pose an unacceptable risk to the accuracy of Marketplace eligibility determinations, operations, applicants, or enrollees, or Marketplace information technology systems. This policy will improve the security and integrity of the Marketplace, resulting in fewer unauthorized changes to coverage and preventing further harm to consumers and compliant agents and brokers.​

Updating the Model Consent Form: CMS is finalizing updates to its model consent form, which was created to help agents, brokers, and web-brokers document consent from consumers to assist with their Marketplace enrollments and submission of Marketplace eligibility applications. The updated form will help document that a consumer or their authorized representative reviewed and confirmed the accuracy of their eligibility application information before their application was submitted to a Marketplace. The updated model consent form will also include scripts that agents, brokers, and web brokers can use to document compliance with requirements for consumer consent and consumer review and confirmation of the accuracy of their eligibility application information via an audio recording. These updates will increase transparency and accountability in the application and enrollment process, help ensure that Marketplace application information is accurate, and reduce the risk of financial errors, such as receiving an incorrect advance payment of the premium tax credit (APTC) amount that a consumer would need to repay during tax reconciliation, or enrollment in health care coverage without a consumer’s consent.

Patients who have been enrolled in a Marketplace plan without their knowledge, should contact the Marketplace Call Center so official Marketplace representatives can resolve any coverage issues. If the Marketplace representatives determine a patient has been enrolled or had their plan switched without their knowledge, the representatives can work with the insurer and the Internal Revenue Service (IRS) to:

• Make sure the unauthorized plan is cancelled
• Have inaccurate costs repaid to the patient
• Get corrected tax forms

This guidance is also expected to be reviewed by the Trump administration.