CMS has made its goal clear: it wants to enhance the affordability, integrity, and accessibility of the ACA Marketplace. Key provisions of the 2026 ACA Final Rule include:
- Stronger oversight of agent and broker conduct, aiming to protect consumers from misleading or unauthorized enrollments.
- Tighter regulations on plan marketing and display to reduce confusion and help consumers make informed decisions.
- Enhanced network adequacy and essential community provider (ECP) standards to ensure access to care.
- Continued investment in automatic re-enrollment systems and premium tax credit eligibility improvements.
CMS projects these changes will reduce overall administrative costs and increase efficiency, both of which, in theory, can lead to lower 2026 consumer premiums.
But Will Premiums Really Drop? A Ground-Level Look Tells a Different Story
While CMS is optimistic, the reality on the ground shows a different picture, especially in certain high-cost states. As of mid-2025, carriers in New York, Connecticut, and Washington have already filed for significant premium rate increases for the 2026 plan year.
The proposed increases range from high single-digit to double-digit percentages, driven by:
- Rising healthcare utilization and provider costs
- Increasing demand for mental health and chronic condition management
- The phasing out of temporary pandemic-related cost protections
- Higher inflation impacts medical and drug prices.
Healthcare costs are rising faster than policy reforms can contain them, especially in regions with more fragmented provider networks and insurance markets.
The ACA Agent Opportunity to Lead
Despite these conflicting trends, ACA agents are more valuable than ever. In a market where consumers may face higher premiums or plan confusion, your guidance is the difference between frustration and clarity.
Here’s how agents should approach this moment:
Go the Extra Mile to Match Clients with Budget-Friendly Plans
Utilize your knowledge of local carrier networks, subsidies, and plan tiers to find a solution that fits each client’s needs and financial reality. Even slight differences in copays, deductibles, or provider networks can be the key to long-term satisfaction.
Sell Ancillary Products That Add Value
Products like critical illness, hospital indemnity, dental, and vision plans are more relevant than ever. These supplemental offerings:
- Offset out-of-pocket costs from high-deductible plans
- Protect clients from surprise medical expenses
- Increase revenue per household.
Build Trust to Boost Retention
With regulatory shifts and rising premiums, loyalty is built through transparency and education. Agents who invest the time to explain these changes build lasting relationships and referrals.
While the CMS ACA Final Rule reflects a continued commitment to ACA market stability and affordability, premium trends may not align with the agency’s optimism in the near term. Agents should see this as an opportunity to elevate their role as trusted advisors.
Staying informed, offering strategic plan pairings, and educating clients on protecting themselves financially are key aspects of what a trusted advisor does, resulting in a growing book of business that’s easier to retain, even in a high-premium environment.
As the Agility ACA product specialist, I’m here to address any questions you may have about these changes and the opportunities they present to agents. I can also refer you to our Supplement product specialist, who can answer any questions you have specifically about these products.
Contact Agility Producer Support at (866) 590-9771 or email support@enrollinsurance.com for answers to any insurance questions. Agility can also add you to our free, weekly email list for tips and vital information!
