The Centers for Medicare & Medicaid Services has issued its annual “Notice of Benefit and Payment Parameters for 2027; Basic Health Program,” which governs health plans offered through the federal health insurance exchange and state exchanges as established under the Affordable Care Act.

Major provisions under the new final rule include:

  • Eliminating the current requirement that insurers offer standardized health plans at each of the traditional plan levels (bronze, silver, gold, and platinum) in favor of permitting insurers to offer unlimited numbers of plans at each level.
  • Introducing a new non-network plan option in which insurers can now offer exchange plans that have no provider networks, with the plans setting fixed-amount payments for specific medical services. Payers will need to demonstrate that enough providers in the plans’ service areas will accept those payments.  This will take effect in 2028 and not in 2027, as CMS originally proposed.
  • Permitting people to enroll in catastrophic health plans that offer fewer benefits at lower monthly premiums but requiring much greater cost-sharing and permitting such enrollment for up to ten consecutive years. CMS also has expanded the criteria for the hardship exemption required to enroll in catastrophic plans.
  • Creating greater flexibility for cost-sharing design, such as removing cost-sharing limits for state-required benefits that are in addition to essential health benefits.
  • Reducing eligibility for tax credits to help pay for exchange plans, limiting that eligibility to citizens and “lawful immigrants” while excluding refugees, asylum recipients, and others.
  • Introducing more rigorous review of eligibility for individuals applying for tax credits and those seeking to enroll in plans during special enrollment periods.

The final rule also introduces expanded regulation of marketing brokers and practices; eliminates routine adult dental services as an essential health benefit; makes it easier for states to establish their own health exchanges; gives states greater authority over their own exchanges, including the ability to determine whether plans have adequate provider networks; and reduces the fees insurers pay to participate in insurance exchanges.

Learn more about the changes CMS will implement for activity governed by the Affordable Care Act from this CMS news release; an accompanying CMS fact sheet; the final CMS rule; and the Healthcare Dive article “CMS finalizes major changes to ACA exchanges, including greater access to catastrophic plans.”