New CMS Rule on Health Plans: Key Updates for 2026

On February 9, the Centers for Medicare & Medicaid Services (CMS) introduced a proposed rule focused on the Notice of Benefit and Payment Parameters for 2026. This significant development affects issuers providing Qualified Health Plans (QHPs) through both the Federally Facilitated Marketplace and state-based exchanges operating on the federal platform. These exchanges, established under the Patient Protection and Affordable Care Act, are critical for qualified individuals and employers who need health insurance coverage through QHPs.

Key Elements of the Proposed Rule

The proposed rule empowers issuers to offer catastrophic plans lasting from one to ten years. It also endorses the introduction of low-deductible plans while allowing for higher out-of-pocket maximums, aligning with regulatory compliance requirements. Additionally, the rule proposes hardship exemptions for individuals aged 30 and above, expanding access to catastrophic coverage. Another important aspect is the adjustment of Essential Health Benefits to ensure federal subsidies do not encompass certain state-mandated benefits. Furthermore, it proposes changes to procedures concerning network adequacy and provider access, emphasizing regulatory and compliance oversight.

Stakeholders have the opportunity to comment on the proposed rule until March 13, allowing inputs on this pivotal shift in QHPs' structuring and offering. This development will significantly impact issuers, policyholders, and regulatory practices within the insurance industry, particularly affecting payer and provider dynamics and compliance in underwriting and claims processing. The proposal is poised to influence risk management strategies and shape the industry's future regulatory landscape.