On Feb. 9, the Centers for Medicare & Medicaid Services (CMS) issued the Notice of Benefit and Payment Parameters proposed rule for 2026, relating to issuers offering qualified health plans (QHPs) through federally facilitated Marketplace 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.
Highlights of the proposed rule include:
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Allowing issuers greater flexibility to offer catastrophic plans for terms of one year or up to ten consecutive years.
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Permitting the use of low-deductible plans with higher out-of-pocket maximums.
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Adding hardship exemptions for individuals 30 years of age or older to allow them to enroll in catastrophic coverage.
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Revising Essential Health Benefits so federal subsidies are not used to cover certain state-mandated benefits.
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Making changes to network adequacy and provider access reviews.
The CMS is accepting comments until March 13.