Agility is providing a brief summary of the CMS 2027 Notice of Benefit and Payment Parameters Final Rule fact sheet below:
The rule updates the 2027 Affordable Care Act Marketplace policy, focusing on program integrity, consumer protections, insurer flexibility, and state flexibility. The key changes include:
- Stronger oversight of brokers and marketing – it bans misleading tactics like false “$0 premium” claims and requires standardized consumer consent/documentation forms starting in 2028.
- More income and eligibility verification – CMS tightens checks on subsidy eligibility, including stricter verification for low-income applicants and failure-to-file/reconcile tax cases.
- Marketplace plan flexibility:
- Removes the requirement for standardized ACA plans.
- Removes limits on non-standardized plans.
- Allows new types of non-network Qualified Health Plans beginning in 2028.
- Expanded catastrophic coverage access:
- More hardship exemptions.
- Multi-year catastrophic plans (up to 10 years).
- More flexibility in cost-sharing design.
- Lower Marketplace user fees for insurers in federally facilitated exchanges in 2027.
- States get more control over provider-network and Essential Community Provider reviews for exchange plans.
- CMS kept the existing rule requiring insurers to contract with at least 35% of Essential Community Providers, rejecting a proposed reduction to 20%.
- The rule also implements parts of the new Working Families Tax Cut legislation, including changes limiting premium tax credit eligibility for certain lawfully present immigrants below 100% of the federal poverty level.
- CMS will no longer allow NPN adding or changing NPN on the healthcare.gov system
- CMS will no longer assist with three-way call enrollments if there is no SSN or immigrant documentation information.
- NOTE: In a call with CMS last week, they said additional crackdowns on enrollments without socials are coming in the near future.
- Reminder: AGENTS/PRODUCERS are not assisters, and agent info should not be provided in the assister fields. This information is not passed to plan sponsors, and agents will not get credit for the enrollment.
Overall, according to CMS, the rule intends to reduce fraud, improve oversight, expand plan innovation, increase state flexibility, and lower administrative costs in the 2027 ACA program.
The Agility Difference
Agility will continue to provide ACA and all insurance agents with updates like this, so you know what is happening and can best prepare for 2027. As the insurance market continues to evolve, Agility helps you deliver the best client experience with our team’s decades of expertise, setting you up for growth.
With Agility, you receive the latest information like this about what’s happening in the insurance industry and what you can do about it for your immediate use. If you have any questions about this material, please contact our Dedicated Producer Support at (866) 590-9771 or support@enrollinsurance.com to answer your insurance questions and connect you with our Medicare, ACA, and ancillary experts. They can also add you to our weekly email list for tips and updates.
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