The Centers for Medicare & Medicaid Services (CMS) on March 19 issued the Marketplace Integrity and Affordability proposed rule (PDF), which revises standards for issuers offering qualified health plans (QHPs) through federally facilitated Exchanges and state-based Exchanges on the federal platform. Exchanges are entities, established under the Patient Protection and Affordable Care Act (P.L. 111-148, PDF), through which qualified individuals and qualified employers can purchase health insurance coverage in QHPs.
The CMS proposes to reverse many of the changes to Exchange coverage made during the Biden administration, including ending eligibility for QHP and Basic Health Program coverage for individuals with Deferred Action for Childhood Arrivals status. The rule also proposes to prohibit individual and small group health plans from offering gender-affirming care as an essential health benefit.
Other provisions of the proposed rule would:
- Shorten the open enrollment period by one month, to run from Nov. 1 to Dec. 15, instead of Jan. 15.
- Impose pre-verification procedures before an individual can enroll during special enrollment periods.
- Require additional income verification checks for premium tax credits.
- Add limitations on reenrollment, such as by denying enrollment until an enrollee pays past-due premiums and charging a $5 premium for individuals with fully subsidized coverage who are automatically enrolled before confirming their plan.
Certain provisions of the proposed rule would go into effect in the 2026 plan year, with the remaining proposals taking effect in the 2027 plan year. Comments are due April 11.