CMS Proposes Draft Regulations for ACA Adjustments in 2027

The Centers for Medicare & Medicaid Services (CMS) released draft regulations for adjustments to the Affordable Care Act (ACA) insurance criteria and Marketplace plan operations in 2027. The Notice of Benefit and Payment Parameters (NBPP) aims to address changes from 2025, including the end of enhanced premium tax credits, new eligibility restrictions, and increased paperwork. These adjustments are expected to impact enrollment and premiums significantly.

CMS received 1,044 public comments in response, indicating heightened engagement compared to its 2026 proposal. The analysis investigates feedback from insurers and brokers, with future installments set to review consumer advocacy, provider feedback, and regulatory input.

Insurers highlighted the approaching deadline for Marketplace plan certification, complicating preparation efforts. Companies like Oscar Health emphasized the need for a robust individual market to support initiatives like Individual Coverage Health Reimbursement Accounts.

The proposal recommends rescinding certain Biden administration policies, such as federal oversight on network adequacy and mandates for essential community providers. Insurers support state discretion in these areas but raised concerns about potential consumer access issues.

States may be required to cover costs for benefits mandated after December 31, 2011. Insurers generally agree with this move but suggest delaying implementation to 2028 due to state legislative timeline challenges.

Proposals affecting standard and non-standard plan requirements include removing standardized plan preferences. While insurers back this idea, they stress the importance of maintaining plan diversity to reduce consumer confusion and call for enhanced decision-making tools.

Insurers also raised concerns about income verification processes, urging CMS to consider the implications of recent program integrity measures before implementing new requirements, as these may impact the risk pool.

Web-broker-operated state-based Marketplaces (SBMs) received mixed reactions, with stakeholders worried about trust issues and consumer misinformation risks. Insurers were cautious about non-network plans due to consumer protection and market stability concerns, with Sidecar Health Insurance Company being the sole supporter, citing potential competition benefits.

Regarding catastrophic plans, proposals to expand eligibility and market them as multi-year options faced skepticism due to pricing and management challenges compared to traditional network-based products. Lastly, CMS's consideration of modifications to the medical loss ratio (MLR) standards received varied feedback, with insurers advocating for state-led evaluations of market stability.

This summary reflects insurer commentary on CMS's proposed rules, not encompassing all viewpoints or proposal aspects. Interested parties are directed to the official comment repository for further exploration of stakeholder responses.