On May 15, 2026, the U.S. Department of Health and Human Services issued the final "HHS Notice of Benefit and Payment Parameters for 2027" -- the annual rule that governs how health insurance plans are sold and priced on ACA marketplaces. The rule takes effect July 20, 2026, and applies to coverage beginning January 1, 2027. Here is what consumers and agents need to know.
Lower Marketplace User Fees for Insurers
One of the most direct changes in the final rule is a reduction in the fees insurers pay to participate in federally facilitated exchanges (FFEs). For 2027, the FFE user fee rate drops to 1.9% of monthly premiums, down from the current 2026 rate. State-based exchanges on the federal platform (SBE-FPs) see an even lower rate of 1.5%. These lower fees could modestly reduce overhead costs for insurers -- though there is no guarantee those savings will be passed to consumers as lower premiums.
Crackdown on Deceptive Agent and Broker Practices
The rule adds explicit examples of prohibited marketing practices for insurance agents, brokers, and web-brokers who help consumers enroll through federal exchanges. Specifically banned practices now include:
- Offering cash, rebates, or cash equivalents to induce enrollment
- Falsely claiming consumers will always qualify for zero-dollar or free coverage
- Misrepresenting enrollment timelines and deadlines
CMS is also requiring that marketing materials be retained and made available for monitoring and enforcement. This responds to ongoing concerns about unauthorized enrollments and misleading sales tactics that have been reported to state insurance departments since expanded marketplace access began.
More Control Handed to States
The 2027 rule significantly expands state authority over provider network reviews. FFE states may now elect to conduct their own provider access reviews and Essential Community Provider (ECP) certification reviews for plans sold on federal exchanges -- provided CMS determines the state has sufficient authority and technical capacity. This means consumers in participating states could see their state government taking a more active role in vetting whether marketplace plans include enough doctors, hospitals, and safety-net providers.
CMS held firm on requiring insurers to contract with at least 35% of Essential Community Providers in a service area, rejecting a proposed reduction to 20%. Essential Community Providers include federally qualified health centers, Ryan White HIV/AIDS Program grantees, and safety-net hospitals that serve low-income populations.
ACA Plan Design Changes Starting 2028
Looking ahead, the rule opens the door to new types of non-network Qualified Health Plans beginning in 2028. It also removes the requirement for standardized ACA plan designs and lifts limits on the number of non-standardized plans insurers can offer. This could give consumers more choices -- but may also make plan comparisons more complex.
Stricter Subsidy Verification
CMS is tightening income and eligibility checks for premium tax credit (subsidy) applicants. The rule introduces stricter verification for low-income applicants and for consumers who have failed to file or reconcile their taxes in prior years. If you receive ACA subsidies, making sure your tax filings are current becomes more important than ever to avoid a subsidy clawback at tax time.
What This Means for 2027 Open Enrollment
Open enrollment for 2027 ACA marketplace plans will run in the fall of 2026. The rule's changes won't affect your current 2026 plan, but they will shape the options available when you shop for next year's coverage. Key takeaways:
- Agent practices are more strictly regulated -- if an agent promises you free coverage or offers incentives to enroll, that is now explicitly prohibited.
- States may play a bigger role in reviewing network adequacy, which could improve plan quality in some states.
- Keep your taxes current -- subsidy verification is tightening, and unfiled returns could affect your eligibility.
- More plan variety in 2028 -- the elimination of standardized plan requirements means future shopping may require closer comparison of benefits and cost-sharing structures.
Use our Health Insurance Calculator to estimate your 2026 premium and subsidy before the next open enrollment period opens.
The Standardized Plan Requirement: What Removing It Means
One of the more consequential longer-term changes in the 2027 final rule is the removal of the requirement for standardized ACA plan designs, effective for 2028. Since 2017, the ACA has required that plans on the federal marketplace offer at least one standardized option at each metal tier — a plan with predetermined cost-sharing structures (set deductibles, copays, and out-of-pocket maxima) designed to make plan comparison straightforward.
The rationale: when plans all use similar cost-sharing structures within a metal tier, consumers can compare premiums more directly without needing to model every scenario. The complexity of health insurance cost-sharing — different copays for different service types, deductibles that apply to some services but not others, varying coinsurance rates — makes genuine plan comparison extraordinarily difficult without standardization.
Removing the standardized plan requirement returns the marketplace to a landscape where every plan may have a unique cost-sharing structure. This creates more product variety but also more comparison complexity. Consumers choosing 2028 plans will need to be more careful about modeling total annual costs rather than relying on premium comparisons alone.
Essential Community Provider Requirements: Why the 35% Floor Was Defended
CMS rejected the proposed reduction in the Essential Community Provider (ECP) contracting threshold from 35% to 20%, and this decision deserves more attention than it typically receives in policy coverage. ECPs are providers that primarily serve low-income and underserved populations: federally qualified health centers (FQHCs), Ryan White HIV/AIDS clinics, safety-net hospitals, and Indian Health Service facilities.
The requirement that marketplace plans contract with at least 35% of ECPs in their service area ensures that low-income enrollees — who disproportionately rely on these safety-net providers — can actually access them using their marketplace coverage. A plan that doesn't include the FQHC that serves your community is functionally less useful for you even if its premium and deductible look competitive.
Had CMS reduced the threshold to 20%, insurers would have had more flexibility to build narrow networks that excluded safety-net providers — potentially saving premium costs but leaving the most vulnerable enrollees without access to their established care relationships. The decision to hold at 35% reflects a deliberate policy choice to maintain access for this population.
How to Protect Yourself During 2026 Open Enrollment
The rule's practical consumer implications converge on a few concrete actions during the fall 2026 open enrollment period:
- Be skeptical of agents offering unusually attractive deals: The explicit prohibition on cash incentives for enrollment reflects real problems in the market. If an agent is offering gift cards, rebates, or making promises about free coverage, those practices are now explicitly prohibited and should be reported to CMS.
- Reconcile your 2025 taxes before enrolling for 2027: The stricter verification requirements mean that beneficiaries with outstanding tax reconciliation issues may face subsidy delays or interruptions. Filing your 2025 return accurately and on time before the 2026 open enrollment window closes reduces your risk.
- Verify your network before selecting a plan: With states potentially taking on more active network adequacy roles, plan networks may change between plan years. Verify that your specific providers are in-network for any plan you consider — don't assume last year's network carries over.
- Model 2028 costs if considering a multi-year strategy: If you're a relatively healthy consumer who has been relying on a standardized plan's predictable cost structure, be aware that 2028 plans will no longer have that standardization. Starting to understand plan cost-sharing structures now will make 2028 shopping easier.
Use our Health Insurance Calculator to model your coverage costs and compare plan options as open enrollment approaches.