CMS is implementing a final rule that will shorten the open enrollment period on the ACA exchange and create stricter eligibility verifications for enrollees.
In a June 20 news release, the agency said the changes will lower individual premiums by around 5% on average, and save around $12 billion in 2026 by cracking down on improper enrollments.
CMS estimated as many as 5 million people may have improperly enrolled in ACA plans “enabled by weakened verification process and expanded premium subsidies.”
Here are five things to know:
- The agency will repeal the monthly special enrollment period for individuals with incomes below 150% of the federal poverty guidelines. CMS said some agents and brokers used the period to enroll ineligible consumers and switch members’ plans without their consent.
- CMS will tighten eligibility verifications, requiring beneficiaries to verify their incomes to qualify for premium subsidies and conduct eligibility checks for most special enrollments. The agency said the changes would improve the risk pool, which can lower premiums.
- Beginning with plan year 2027, the agency will end the open enrollment period on Dec. 31, rather than Jan. 15. CMS said the change encourages individuals to maintain year-round coverage.
- CMS will also prohibit federal subsidies provided to ACA plans to be used for gender-affirming care.
- The agency will also restrict Deferred Action for Childhood Arrivals recipients from enrolling in ACA coverage. In 2024, CMS said it would allow DACA recipients to enroll in marketplace plans, but a federal judge blocked the decision.
The final rules come as expanded subsidies for marketplace coverage are set to expire at the end of 2025. The enhanced subsidies spurred record enrollment on the exchange, reaching 24.3 million in 2025. These subsidies have reduced average premium payments by around 44%, according to KFF.
Read the full rule here.
