What Do the New ACA Marketplace Rules Mean for You?
If you've heard about proposed changes to the ACA Marketplace, you're not alone. The Centers for Medicare & Medicaid Services (CMS) has recently finalized a new rule aimed at strengthening the integrity and affordability of the individual market. This rule introduces several notable changes, including new eligibility verification processes and adjustments to the open enrollment period for future years. The changes include:
Changes to Enrollment: The Open Enrollment Period (OEP) will be standardized to end on December 31 for all exchanges starting with the 2027 plan year.
Preventing Improper Enrollment: New policies will help prevent improper enrollments, such as requiring Exchanges to deny eligibility for tax credits if a tax filer has failed to reconcile them for one year.
Stricter Verification: Issuers can now require payment of past-due premiums before effectuating new coverage. The rule also repeals the monthly Special Enrollment Period (SEP) for individuals with household incomes at or below 150% of the federal poverty level.
Exclusion of DACA Recipients: The rule amends the definition of "lawfully present" to exclude Deferred Action for Childhood Arrivals (DACA) recipients, making them ineligible for certain subsidies and plans through the Marketplace.
Plan Flexibility: The rule modifies the methodology for calculating the premium adjustment percentage and widens the de minimis ranges for actuarial value, giving health plan issuers greater flexibility in plan design.
I understand these changes can be confusing. The good news is that I am here to help you navigate them. For a comprehensive overview of the new policies directly from the government source, please see the official fact sheet linked below.
