CMS proposed rule changes
Shorten the annual Open Enrollment Period for individual market coverage offered through ACA Marketplaces to December 15. It currently runs from November 1 – January 15.
Require all Marketplaces to reinstitute pre-enrollment verification of eligibility for SEPs and requiring further proof of income when there is no tax data available for verification. This seems like a way to prevent those in non-expansion states from lying to get to 100% FPL and subsidies.
End the special enrollment period (SEP) for individuals with household incomes below 150 percent of the federal poverty level (FPL). I think this would sunset in 2026 anyway.
Require that when an enrollee does not proactively verify their ongoing eligibility for a fully subsidized plan, Marketplaces must continue to re-enroll that individual into the same plan but must also reduce the amount of advance payment of the premium tax credit by $5. This could be eliminated once the enrollee confirms their eligibility.
Sex-trait modification to the list of items and services that may not be covered as essential health benefits beginning in plan year 2026.
Revert to a previous definition of “lawfully present” that excludes Deferred Action for Childhood Arrivals (DACA) recipients.
Shorten the annual Open Enrollment Period for individual market coverage offered through ACA Marketplaces to December 15. It currently runs from November 1 – January 15.
Require all Marketplaces to reinstitute pre-enrollment verification of eligibility for SEPs and requiring further proof of income when there is no tax data available for verification. This seems like a way to prevent those in non-expansion states from lying to get to 100% FPL and subsidies.
End the special enrollment period (SEP) for individuals with household incomes below 150 percent of the federal poverty level (FPL). I think this would sunset in 2026 anyway.
Require that when an enrollee does not proactively verify their ongoing eligibility for a fully subsidized plan, Marketplaces must continue to re-enroll that individual into the same plan but must also reduce the amount of advance payment of the premium tax credit by $5. This could be eliminated once the enrollee confirms their eligibility.
Sex-trait modification to the list of items and services that may not be covered as essential health benefits beginning in plan year 2026.
Revert to a previous definition of “lawfully present” that excludes Deferred Action for Childhood Arrivals (DACA) recipients.
