CMS Finalizes 2025 Rule Tightening ACA Marketplace Enrollment and Coverage in Washington

The Centers for Medicare and Medicaid Services (CMS) finalized its 2025 Marketplace Integrity and Affordability rule, impacting consumers purchasing health plans through state-based exchanges like Washington Healthplanfinder.

The new rule introduces a shortened open enrollment period, increased administrative requirements, and tighter eligibility criteria for premium tax credits, potentially complicating access to affordable coverage for many individuals. Washington state officials, including Insurance Commissioner Patty Kuderer, have expressed concerns that the rule imposes unnecessary burdens without addressing fraud effectively, noting Washington's existing safeguards against improper enrollments.

The rule also restricts states' ability to select benchmark plans, specifically excluding coverage for gender-affirming care from qualified health plans under the Affordable Care Act, affecting plan options available through exchanges. Health insurers in Washington have requested an average rate increase of 21.2% for 2026 individual market plans, which are currently under actuarial review, raising concerns about rising premiums and out-of-pocket costs amid evolving federal policies. With the rule's implementation set to begin 60 days after publication and additional provisions rolling out through 2026 and 2027, the regulatory and compliance landscape for state health exchanges is set to become more complex, affecting payer, provider, and consumer interactions in the insurance marketplace.