On February 9, the Centers for Medicare & Medicaid Services (CMS) released its 2027 proposed standards for the health insurance marketplaces, including the issuers and brokers who assist marketplace enrollees.
Notably, the proposed rule would allow CMS to certify non-network health plans as qualified health plans (QHPs), beginning in plan year 2027, on the basis that non-network plans provide an opportunity for individual enrollees to lower their health care costs through individualized price comparisons and negotiations with providers.
The proposed rule also would codify guidance issued by the Trump Administration in September 2025 expanding the catastrophic plan hardship exemption to include individuals who are ineligible for advanced premium tax credits (APTC) or cost sharing reductions (CSRs) due to projected household income. That change currently applies to individuals in all states except California, Connecticut, Maryland, and the District of Columbia. The proposed rule expands this exemption to include individuals in all states aged 30 and older if they meet the income qualifications. Currently, consumers under age 30 can enroll in catastrophic coverage without a hardship exemption. CMS suggests in the rule that “substantial premium increases” warrant expansion of the hardship exception. However, expanding catastrophic plan eligibility could have implications for the insurance marketplace risk pools.
Also of note, the proposed rule would prohibit plan issuers from providing non-pediatric dental as an essential health benefit (EHB), and it would increase state responsibilities for mandating benefits beyond the federally-required EHB package. Specifically, any state-required benefit would be considered “in addition to EHB”—and thus not EHB—if it is required by state action after Dec. 31, 2011. Under this proposed policy, states would be required to defray the cost of these additional benefits for enrollees in QHPs offered through the Exchange, regardless of whether the benefit is embedded in the state’s EHB-benchmark plan.
The proposed rule explains that when states enact benefit mandates, plan premiums must generally increase to account for the additional coverage. In the individual market (in which QHPs are sold), if state-required benefits are EHB, the associated premium increases will be entirely offset for consumers receiving APTC by higher federal APTC expenditures. While premium increases associated with the accumulation of state-required benefits that are EHB are offset for consumers receiving APTCs, they are not offset for unsubsidized enrollees.
CMS is accepting comments on the expansive proposed rule until March 13.
Proposed Rule (CMS-9883-P)
CMS Press Release
CMS Fact Sheet
CMS Presentation Slide Deck