On January 13, 2025, HHS (Department of Health & Human Services) CMS (Centers for Medicare & Medicaid Services) issued the final 2026 Payment Notice, setting standards for the ACA Health Insurance Marketplaces, health insurers, and agents/brokers who work to enroll millions of consumers in ACA coverage.
More safeguards to protect consumers
The HHS Notice of Benefit and Payment Parameters for 2026 (also called “final 2026 Payment Notice”) is scheduled to be published on January 15, 2025 to the Federal Register.
This rule set in place additional safeguards for the protection of consumers from unauthorized changes to their health insurance coverage, beginning in 2026, in addition to options to ensure the integrity of the Federally-facilitated Marketplaces (FFMs). Also beginning in Plan Year (PY) 2026, this rule will enable consumers to more easily understand the costs of their coverage when enrolling through HealthCare.gov.
Provisions regarding agents/brokers
Finalizing policy on reviews and enforcement actions
A policy being finalized by CMS will enable it to take enforcement actions, when appropriate, against lead agents at insurance agencies when Marketplace standards are violated, and hold them responsible.
Model consent form updates
- Updates to the model consent form are being finalized to help document that the accuracy of the consumer’s eligibility application information was reviewed, either by the consumer or their authorized representative, before being submitted to a Marketplace.
- Scripts will be included to be used by agents/brokers to obtain consent via an audio recording, ensuring that they are in compliance with regulations for consumer consent, review, and confirmation of the accuracy of the application.
Immediate suspension for Marketplace agents/brokers
Authority will be expanded for CMS under this new policy, which will enable them to immediately suspend an agent or broker’s access to transact information with the Marketplace in the event that circumstances are discovered which pose an unacceptable risk to the:
- Accuracy of eligibility determinations,
- Operations,
- Applicants,
- Enrollees, or
- Marketplace information technology systems.
Notification of Enrollees
Extending consumer notification requirements to two tax years
The requirement will be finalized for Marketplaces to notify enrollees (or their tax filers) who have failed to file their federal income taxes for two consecutive tax years, therefore failing to reconcile their APTC for two consecutive years, that they are at risk of losing their APTC.
Further information and the full fact sheet for this bulletin from HHS CMS is available via the link provided below.
HHS Notice of Benefit and Payment Parameters for 2026 Final Rule | CMS
