HHS made the announcement in its Notice of Benefit and Payment Parameters for 2027 Proposed Rule.
The Department of Health and Human Services has announced the repeal of standardized plan options in Affordable Care Act coverage.
The Centers for Medicare and Medicaid Services proposes to discontinue the requirement for insurers to offer standardized plan options in the individual market and also to discontinue the limit on the number of non-standardized plan options that may be offered.
CMS made the proposal in the Notice of Benefit and Payment Parameters for 2027 Proposed Rule issued on Monday.
Insurers may choose whether to discontinue the chronic and high-cost condition plans originally offered through the non-standardized plan exceptions or to continue offering them with either the same or modified cost sharing, CMS said.
These proposed policies are being introduced to reduce issuer and HHS burden and regulatory complexity and to allow insurers to innovate plan design, CMS said.
CMS formerly regulated insurers on the number of allowed nonstandard plan designs.
CMS proposes standards under which catastrophic plans may have terms of multiple consecutive years of up to 10 years and seeks comment on whether to issue similar standards for metal-level plans.
Related to that proposal, CMS proposes to allow issuers to make plan-level adjustments to the index rate for such catastrophic plans, and to allow issuers of such plans to apply the applicable cost-sharing for each plan year in the contract, prorated monthly.
Also, multi-year catastrophic plans would be permitted to use value-based insurance designs to cover preventive services over and above those that currently must be covered under certain recommendations and guidelines, before an enrollee satisfies the deductible or hits the out-of-pocked maximum.
Additionally, CMS proposes to change the permissible cost-sharing parameters for bronze plans and to update cost-sharing requirements for catastrophic plans, beginning in 2027.
Other proposals include:
In the ACA, CMS charges user fees to participating issuers as a means of generating funding to support operations. For the 2027 benefit year, CMS proposes an federally-facilitated exchange user fee rate of 2.5% of monthly premiums and state-based exchanges user fee rate of 2% of monthly premiums, which are the same as the user fee rates established for the 2026 benefit year.
CMS proposes to sunset the requirements that HHS will approve vendors to facilitate annual agent and broker training on an annual basis for a given plan year. This effectively discontinues the vendor program, CMS said. Agents and brokers will still have full access to complete annual exchange training and registration requirements via the Marketplace Learning Management System.
CMS proposes to re-introduce the requirement for consumers to submit documents to verify their income when data sources indicate household income is under 100% of the federal poverty level. This was finalized in the 2025 Marketplace Integrity and Affordability final rule and then stayed by the court in City of Columbus et. al. v. Kennedy, CMS said.
The proposed rule sets standards for exchanges, health insurance issuers, brokers and agents who connect millions of consumers to Affordable Care Act coverage.
CMS proposes implementing a State Exchange Improper Payment Measurement program in 2027 to measure improper payments of advance payments of the premium tax credit administered by state-based exchanges.
CMS currently has a process in place to measure improper payments of the tax credits for the federal exchanges, but not one for the state-based exchanges.
CMS proposes to restore aspects of network adequacy authority back to the state-based exchanges. Each qualifying health plan would need to provide sufficient choices of providers in a manner that meets standards specified by law for network and non-network plans.
“These proposed policies recognize that states often possess unique knowledge of local factors including on market conditions, geographic constraints, provider shortages and population demographics,” CMS said.
CMS proposes to allow non-network plans to receive qualifying health plan certification beginning with plan year 2027, by demonstrating a sufficient choice of providers in a manner consistent with ACA law.
Unlike network-based plans, non-network plans do not rely on a contracted set of providers that agree in advance to specific terms and negotiated payment rates. These plans set specific benefit amounts for covered services and communicate those benefit amounts to enrollees who may then seek covered services from any provider.
Under this proposal, non-network plans would be required to ensure access to a range of providers that accept the non-network plan’s benefit amount as payment in full, including providers that specialize in mental health and substance use disorder services, to ensure that services will be accessible without unreasonable delay, CMS said.
This proposed policy aims to reduce overall healthcare costs by empowering enrollees to utilize price transparency information to shop for lower prices and negotiate directly with providers, CMS said. This could eliminate administrative overhead associated with traditional network management, potentially resulting in lower premiums.
CMS, on behalf of HHS, is responsible for operating risk adjustment in every state and the District of Columbia for the 2027 benefit year. For the 2027 benefit year, CMS proposes a risk adjustment user fee of $0.20 per member per month, the same user fee rate used for the 2026 benefit year.
To continue keeping the HHS risk adjustment models up to date while promoting model stability, CMS proposes to recalibrate the HHS risk adjustment models for the 2027 benefit year using 2021, 2022, and 2023 benefit year enrollee-level External Data Gathering Environment (EDGE) data.
CMS proposes to establish a new optional exchange model known as the State Exchange Enhanced Direct Enrollment option.
If adopted, this proposal would permit state-based exchanges to adopt a private sector-based approach in which they rely exclusively on web-brokers to operate the consumer-facing websites that facilitate the applicant eligibility and enrollment process.
This proposal would be an alternative to the exchange operating a centralized, consumer-facing eligibility application and enrollment website on its own state website.
Accordingly, CMS also proposes to remove the requirement that state-based exchanges must operate a centralized consumer-facing eligibility and enrollment website.
CMS proposes to prohibit issuers from including routine non-pediatric (adult) dental services as an elected health benefit. CMS said it believes this reversal of the policy finalized in the 2025 Payment Notice better aligns with statutory requirements of the ACA, which directs that the scope of the benefits be equal to the scope of benefits provided under a typical employer plan.
To decrease the risk that consumers are improperly enrolled in coverage, CMS seeks comment on whether CMS should temporarily or permanently rescind the option for issuers to implement a fixed-dollar and/or gross percentage-based premium payment threshold for PY 2027 and beyond.
CMS also seeks comments on whether state exchanges should have the flexibility to adopt one or both thresholds, even if they remain unavailable for exchanges on the federal platform.
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