Late Friday, the U.S. District Court for the District of Maryland ruled that seven provisions from the CMS ACA Marketplace Integrity and Affordability Rule are enjoined and cannot go into effect as of today. The Court held that HHS, through CMS, exceeded its statutory authority. The following provisions are blocked:
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$5 per month “junk fee” on fully subsidized enrollees to reconfirm eligibility is ruled unlawful for altering the statutory tax credit formula under 26 U.S.C. § 36B.
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Revised premium adjustment percentage methodology is deemed arbitrary and capricious for raising costs without adequate justification.
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Revised actuarial value (metal tier ranges) is found arbitrary for eroding coverage value.
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Requirement to pay past-due premiums before obtaining new coverage is struck down as an unlawful barrier not authorized by the ACA.
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Special Enrollment Period (SEP) verification burdens is deemed arbitrary, unnecessary, and an enrollment barrier.
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“Failure-to-reconcile” policy (denying APTCs if tax data is not filed) is found contrary to law and an improper condition on subsidies.
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Heightened income verification requirements is ruled arbitrary, with a risk of wrongly denying subsidies.
At this time, there is no indication whether the federal government will appeal the decision, so the order remains in effect. Agility encourages ACA agents to continue their Open Enrollment preparations as planned.
We will keep you updated on developments in this case. In the meantime, remind your clients that ACA Open Enrollment begins on November 1, 2025.
There are many moving pieces to this breaking news, and Agility is here to support you at every step. Our team brings decades of experience and offers numerous ACA policy solutions to help you navigate Open Enrollment.
You can contact Agility Producer Support at (866) 590-9771 or by email at support@enrollinsurance.com for assistance with this issue or any other insurance questions. Agility can also add you to our free weekly email list for tips and vital information to help you maximize your ACA Open Enrollment period (OEP).
