The Trump administration has finalized annual regulations governing the Affordable Care Act’s exchanges, including a plan that would pull back limits on non-standardized plan options offered by insurers.
The final Notice of Benefit Payment Parameters was issued late Friday, and the Centers for Medicare & Medicaid Services said in a press release that the rule aims to crack down on fraud — a focus across wide swaths of the government — and afford states greater control over their marketplaces.
Under the Biden administration, plans were required to offer certain standardized options and a limited number of alternative plans, with the goal of making the shopping experience easier for consumers. In this model, payers were limited to two non-standard plan designs per metal level.
In the new final rule, CMS will roll back those requirements, and will give insurers the option to discontinue the standardized plans or continue offering them, including potential changes to cost-sharing.
In addition, the final NBPP rule will allow insurers to offer catastrophic coverage with terms of up to 10 consecutive plan years, and will expand the hardship exemption that allows people to choose these plans. Catastrophic plans on the exchanges offer generally low-premium but high-deductible options for consumers.
CMS is also finalizing updates to the parameters for cost-sharing in bronze tier and catastrophic plans, a move it says will grant payers greater flexibility. Changes for bronze plans will be in place for plan year 2027, with updates to cost-sharing in catastrophic coverage following in plan year 2028.
Beyond updates to plan designs, the rule revives pre-enrollment verifications previously in place during certain special enrollment periods to better confirm eligibility for premium tax credits, according to the announcement. CMS said this ensures that people who qualify are receiving subsidies, and clarifies marketing messaging for agents and brokers.
Fraudulent or improper enrollments in exchange plans have been a major target in CMS’ efforts to address fraud, waste and abuse across its programs. In its rule for the 2026 plan year, the agency similarly put a spotlight on addressing improper sign-ups.
Based on a report from the free market think tank Paragon Health Institute, CMS said a year ago that more than 5 million individuals may have been improperly enrolled in ACA plans in 2024 alone.
“American taxpayers deserve to know their dollars are going only to people who truly qualify,” said CMS Administrator Mehmet Oz, M.D., in the press release. “This rule strengthens eligibility checks, cracks down on abuse, and gives insurers more flexibility to offer affordable, consumer-focused coverage options.”
The rule also includes multiple provisions aimed at states. CMS said it will grant states the flexibility to tailor certification reviews on provider and community health access to reflect the realities in their local markets. The agency is also removing the transition period for a state to shift from a federally-facilitated exchange to a state-based exchange, per the rule.
States will also be required to defray costs for benefits that they require insurers to include that go beyond the ACA’s essential health benefits. It also plans to lower user fees on both federal and state exchanges, which is expected to help decrease premiums.
It’s been a turbulent year for the ACA exchanges in the lead up to the expiration of enhanced tax credits for marketplace plans. CMS also finalized significant program integrity changes that spooked insurers, with these two factors in tandem being key to a spike in premiums for 2026.
Multiple payers cited membership declines in this market during Q1, with Cigna revealing it would depart the exchanges entirely for 2027 amid the increased uncertainty.
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