The “Big, Beautiful Bill” is going to the President for his signature to become law. This article updates our previous ACA article by outlining the law, which KFF also discusses in depth.
Open Enrollment Period
There are no provisions for the ACA Open Enrollment Period in the law. The CMS Patient Protection and Affordable Care Act (PPACA) Marketplace Integrity and Affordability Final Rule, effective August 25, will shape ACA Open Enrollment.
The changes to the rule don’t take effect until the 2027 ACA Open Enrollment.
Opportunity For Agents
ACA agents have a year to prepare for the following opportunities:
- Prospects have a greater sense of urgency to make choices more quickly.
- Agents need a sharper focus, better organization, and proactive communication to achieve higher conversion rates. This urgency generates more ACA sales activity and revenue.
- On December 16, 2026, ACA agents should reach out to their ACA clients with supplemental products to address coverage gaps (vision, dental), high-cost shares (hospital indemnity), and any other issues your clients need to address.
SEPs and Tax Credit Eligibility (effective for plan years after December 31, 2025)
- Low-income SEPs end.
- Prospects enrolling in an ACA plan with a non-qualified Life Experience (QLE) SEP are not eligible to receive premium tax credits or Cost-Sharing Reductions (CSRs).
Opportunity For Agents
- This means lower churn of your current clients.
- Diversify your product portfolio using ICHRA, Medicare, and supplemental products as reasonable solutions to explore to diversify your income profile.
ACA Marketplace Coverage Eligibility for Lawfully Present Immigrants (effective January 1, 2027)
- Does not change CSR eligibility language.
- Does not restrict eligibility for Basic Health Programs to specific classes of eligible aliens.
- Only lawful permanent residents (LPRs or “green card” holders), Compact of Free Association (COFA) migrants residing in the U.S., or certain immigrants from Cuba and Haiti are eligible for subsidized ACA Marketplace coverage. Refugees, asylees, and people with Temporary Protected Status are no longer eligible.
- Effective January 1, 2026, Marketplace eligibility will end for all lawfully present immigrants with incomes at or below 100% of the FPL.
Opportunity For Agents
- Inform any immigrant clients meeting these criteria about their loss of eligibility.
- Confirm with your state’s Medicaid agency if there are any options for these clients to obtain coverage through these programs.
Pre-enrollment Verification of Eligibility for Premium Tax Credit (PTC) (effective taxable years beginning after December 31, 2027)
- Exchanges are not required to verify consumer eligibility for CSRs again once a consumer qualifies for PTCs.
- Requires exchanges to use the applicant’s “household income” for verification.
- Requires exchanges to verify whether the applicant is an “eligible alien.”
- Exchanges may use third-party sources and available data for verification.
- Verification requirements may be waived for individuals enrolling during SEPs due to changes in family size.
Opportunity for Agents
- Greater complexity requires more guidance.
- No more auto-renewals means annual client engagement.
- More Special Enrollment Period (SEP) support to complete successful enrollments.
- Help immigrants and mixed-status families navigate the marketplace and other insurance coverage options.
- Household income calculations offer consulting opportunities for agents to help prevent misreporting, which can affect PTC amounts and potential tax refunds.
- Offer year-round compliance assistance to keep coverage active and subsidies in place.
- Data confusion gives agents a competitive edge by helping resolve data mismatches quickly among frustrated consumers.
Recapture of Excess Premium Tax Credits (effective taxable years beginning after December 31, 2025)
- Includes a safeguard for individuals who project they will make at least 100% FPL but actually have incomes less than 100% FPL.
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- If individuals did not act “with intentional or reckless disregard for facts” when attesting their income, they will not have to repay their excess tax credits.
- Except for the exception listed above, all premium tax credit recipients must repay the full amount of any excess tax credit, regardless of their income.
Opportunity for Agents
Enhance your communication platform capabilities to remind ACA clients of this requirement and to update the Exchange of any household income changes as they occur.
Individual market bronze and catastrophic plans are treated as an HSA-qualified high deductible health plan (HDHP), effective January 1, 2026
Individual market bronze and catastrophic plans can be paired with a health savings account.
Opportunity For Agents
Communicate with your individual and catastrophic plan bronze clients about this provision and provide them with health savings account resources they could choose.
Mike Berglund, our ACA product specialist, is available to assist you with any questions about these changes and the opportunities they present for agents. Our Medicare and Supplement product specialists are available to answer any questions you have about these products.
Contact Agility Producer Support at (866) 590-9771 or email support@enrollinsurance.com to schedule a call or meeting with Mike or to get answers to any insurance questions. Agility can also add you to our free weekly email list for tips and vital information!
