How the 2027 ACA Proposed Rule Could Impact Insurance Agents and Clients

On February 9, the Centers for Medicare & Medicaid Services (CMS) released the HHS Notice of Benefit and Payment Parameters for 2027 Proposed Rule.

The 2027 Affordable Care Act (ACA) proposed rule includes several dramatic changes for the under-65 market.

Overall, the current administration intends to further privatize under-65 health insurance for Americans. With the proposed rule, marketplace plans could more closely resemble privately offered plans we see on the market today. With these dramatic federal changes, we could also start to see more states form their own exchanges.

We’ll unpack the most notable changes for you and your clients below.

Stricter Marketing Rules and Increased Government Oversight

CMS proposes agents adhere to marketing requirements that more closely resemble those of Medicare market. As the law stands now, agents selling ACA plans don’t have to follow marketing guidelines to the same degree as those selling Medicare plans.

Agents would no longer be permitted to market ACA health plans using:

• Cash incentives (e.g. rebates, gift cards, travel vouchers)
• Misleading or false information
• Carrier or government logos
• Images or the likeness of a notable figure (e.g. celebrities, political figures)
  • This includes the production of images or “deep fakes” created with artificial intelligence
• $0-premium messaging
• Inaccurate enrollment/coverage timelines

Additionally, agents would have to provide marketing materials to CMS upon request. We recommend that you maintain records of any marketing materials you use and keep an organized file system that includes clear naming conventions for files (i.e., “marketplace_marketing_spring_2026.pdf”).

CMS plans to heighten penalties for agents who engage in bad-faith activity. Because oversight may increase, maintaining strong compliance practices will be more important than ever.

Requiring CMS’ Approved Consent and Application Forms

According to CMS, there were errors with agents collecting false information or providing forms with missing information in the past.

Agents may soon be required to use CMS’ client consent forms and call scripts when collecting authorization and enrollment information.

Although not yet mandatory, CMS intends to require that all agents use:

• The official CMS consent form
• CMS-approved call scripts

A few months ago, CMS released their model client consent form for agents collecting ACA enrollments. Start preparing now by familiarizing yourself with the form and integrate it into your workflows!

Expanding CMS Authority to Penalize Agents

CMS proposes expanding their ability to take administrative action against agents who attempt to defraud consumers.

Under expanded authority, CMS would be able to:

• Audit or monitor agent activity
• Terminate or restrict those found to be defrauding consumers
• Pose civil penalties against agents

We continue to encourage consistent documentation habits and strong compliance processes.

Removing Dental Benefits from Marketplace Plans

If the proposed rule is finalized, marketplace plans will no longer be allowed to offer dental benefits.

Currently, dental benefits are on track to become standard benefits for marketplace plans beginning in PY2027. Pediatric dental benefits are included in all marketplace plans. CMS’ proposal presents eliminating these benefits for both adults and children.

Dental coverage would become a separate and optional add-on for ACA clients. We suggest having dental options available in your portfolio so you can begin having conversations with clients to prepare them for this change in case it becomes law.

Pre-Enrollment SEP Verification

In a dramatic change, CMS is suggesting that the federal exchange be responsible for verifying at least 75 percent of enrollments associated with a Special Enrollment Period (SEP).

In a dramatic change, CMS is suggesting that the federal exchange be responsible for verifying at least 75 percent of enrollments associated with a Special Enrollment Period (SEP).

This could result in slower processing times and more documentation needed by agents to prevent even slower processing. We encourage you to practice collecting all the mandatory information up front when working with clients and processing enrollments.

This requirement also extends to additional SEPs, not just the SEP triggered when a client loses coverage. With this change, CMS hopes to ensure “consistent application of eligibility criteria and reduce instances of improper enrollments.”

Eliminating Third-Party Training Vendors

Previously, marketplace training could be completed with CMS-approved third-party vendors, like HealthSherpa and INSXCloud. In the 2027 proposed rule, CMS seeks to restrict agents to completing training within the CMS MLMS portal.

Additional Documentation Requirements for Client Income Verification

To further ensure that those who are eligible for marketplace plans receive coverage, CMS is introducing additional documentation obligations for clients whose income falls below 100 percent of the Federal Poverty Line (FPL). Clients could be required to provide W-2s or income statements to prove their annual income levels.

CMS states that health insurance exchanges cannot rely on client attestation when there is no Internal Revenue Service (IRS) data available. Agents would have to assist clients in producing and submitting this documentation when CMS demands it.

Repealing Standardized Plan Options and Limits on Non-Standardized Plans

With the marketplace proposed rule, CMS wants to eliminate standardized ACA plan options. The organization also wants to eliminate the cap on how many non-standardized plan options carriers could offer.

Marketplaces could see more diverse plan designs and options, potentially confusing individuals shopping for coverage on their own. It could become more challenging to compare plans directly to one another.

Plans could have a wide range of deductibles as well as cost-sharing and benefit structures. Every gold metal tier plan may not be the same from one carrier to the next. Agents would be responsible for helping clients identify what plans could be the most valuable and suit their needs the best.

First-time marketplace shoppers could feel overwhelmed from the variety of choices they would be presented with. This would make knowledgeable and trustworthy agents even more valuable in the future of the ACA market.

Citizenship Status Verification for Premium Tax Credits and Subsidies

Consistent with other administration policies, CMS seeks to clearly define “eligible noncitizens” and limit Advanced Premium Tax Credits or Cost-Sharing Reductions to those groups. Lawfully present individuals who are under 100 percent of the FPL and are ineligible for Medicaid due to their immigration status would no longer qualify for subsidies.

If this rule becomes finalized, agents aiding immigrant clients could experience more complex eligibility conversations in the enrollment process and will likely find fewer affordable options.

Failure to File and Reconcile

In the HHS proposed rule, CMS recommends that individuals lose their ability to receive subsidies if they fail to file or reconcile their tax credits for the prior year.

We’ve previously covered how agents can help clients navigate reporting the subsidies they received when completing their income taxes. Agents may need to provide additional support to ensure clients remain compliant and eligible for subsidies.

Permanent Removal of the 150 Percent FPL SEP

CMS proposes completely removing the 150 percent of the FPL SEP after PY2026.

Low-income clients would no longer have the year-round opportunity to enroll in marketplace coverage if their income falls below 150 percent of the FPL.

Expanding the Hardship Exemption and Improvements to Catastrophic Plans

Individuals 30 years and older who lose subsidy eligibility due to income changes could potentially qualify for a hardship exemption, making them eligible for catastrophic plans.

Previously, catastrophic plans were restricted to those under 30 and were only available for short segments. CMS proposes that these plans become available for more individuals and for longer stretches of time. Catastrophic plans could extend for multiple years with terms of up to 10 years under this proposal.

Catastrophic health plans could extend for multiple years with terms up to 10 years under this proposal.

CMS also suggests adjusting plan pricing and subsidy levels for catastrophic and bronze metal tier level plans. Even though catastrophic plans could be renewed for up to 10 years, prices could still change from year to year for clients.

Additionally, catastrophic plans could include more benefits for preventative services before an individual reaches their deductible.

Remember, none of the updated regulations or agent requirements mentioned in this post are codified regulations… yet. We will update agents after CMS issues their 2027 ACA Final Rule.

Ritter is committed to keeping you informed, compliant, and prepared to brace the changes in the ACA marketplace. Register with Ritter today for free agent support and tools that can help you be the most productive agent you can be.