What the Stay on 2025 ACA Final Rule Changes Means

On August 22, 2025, a federal judge in Maryland issued a stay on certain, but not all, provisions of the 2025 Marketplace Integrity and Affordability Final Rule.

Here’s what health insurance agents and their clients need to know about the latest Affordable Care Act (ACA) news.

The Case Against CMS’ 2025 ACA Final Rule

The Centers for Medicare & Medicaid Services (CMS) issued the 2025 Marketplace Integrity and Affordability Final Rule on June 20, 2025. The cities of Columbus, Chicago, and Baltimore, along with the advocacy groups Doctors for America and Main Street Alliance, filed a related lawsuit against Department of Health and Human Services (HHS) on July 1, 2025.

The cities of Columbus, Chicago, and Baltimore, along with the advocacy groups Doctors for America and Main Street Alliance, filed a related lawsuit against HHS on July 1, 2025.

The suit alleges that HHS violated the Administrative Procedure Act when issuing the rules and goes against the ACA itself by adding barriers to health coverage and potentially causing more than two million people to lose coverage.

Judge Brendan A. Hurson of the US District Court for the District of Maryland put certain provisions in the Final Rule on pause ahead of reviewing the lawsuit, believing the plaintiffs are likely to prevail in court.

ACA Changes for 2025 & Beyond Now on Hold

Several, but not all, of the 2025 Marketplace Integrity and Affordability Final Rule changes were set to take effect August 25, 2025; however, the following provisions are on hold until there’s a final ruling in the lawsuit:

• Requiring people to submit income verification if:
  • They attest to eligibility for a premium tax credit (PTC), but federal databases show income less than 100% of the federal poverty level (FPL) (would have taken effect August 25, 2025)
  • No tax data is available (would have taken effect August 25, 2025)
• Allowing insurers to require people to pay past-due premiums as a condition of enrolling in a marketplace plan offered by that insurer in the future, if permitted by state law (would have taken effect August 25, 2025)
• Charging a $5 monthly fee to people enrolled in plans with $0 premiums who don’t actively reenroll in coverage (would have taken effect for Open Enrollment for Plan Year 2026).
• Changing “de minimis” amounts, enabling insurers to offer plans with actuarial values below the standard value (would have taken effect for PY2026)
• Requiring additional verification for commonly used SEPs (would have taken effect for PY2026)
• Determining person ineligible for PTC if they/their tax filer failed to reconcile their advanced PTCs (APTCs) on their tax returns for one year, rather than two years (would have taken effect for PY2026)

The Marketplace Integrity & Affordability Rules Now in Effect

The following ACA Final Rule changes went into effect on August 25, 2025.

• Prohibiting marketplaces from granting applicants an automatic 60-day extension to the 90-day period to resolve income inconsistencies
• Eliminating the Special Enrollment Period for people with incomes at or below 150 percent of the FPL in all states
• DACA recipients will no longer be eligible for marketplace coverage or PTCs
  • Their last day of coverage will be September 30, 2025, in HealthCare.gov states
• Defining a “preponderance of evidence” standard and requiring HHS to apply it when assessing agent, broker, or web-broker terminations for cause

The Wait for Legislative Clarity in the Marketplace Continues

It’s uncertain exactly how the stay will impact the health insurance market, especially with the ACA subsidy cliff growing closer. We can say that the lawsuit could affect ongoing conversations around extending enhanced APTCs — something under-65 health insurers, agents, and policyholders have been holding their breath on.

The lawsuit could affect ongoing conversations around extending enhanced APTCs.

Without the extension of enhanced subsidies, we could see changes in insurance, including millions of ACA enrollees losing coverage. We could also see fewer people enrolled in ACA plans if the stayed provisions end up going into effect, as they could make it harder for individuals to secure and maintain ACA coverage.

Following the News & Educating Clients Will Be Key This OEP

It’s important to note that some of the stayed provisions of the 2025 ACA Final Rule were also signed into law via the One Big Beautiful Bill (OBBB), just with a later start date. For example, exchanges must complete pre-enrollment verification of eligibility for premium tax credit starting January 1, 2028. Depending on the judge’s final ruling, we could see certain provisions delayed until their start date in the OBBB. This adds another element into the mix and could lead to even more confusion among clients and for the marketplace in general.

It’s critical that agents follow the news as there are lots of changes in question, and we could see resolutions closer to the Open Enrollment Period.

It’s critical that agents follow the news, this year especially, as there are lots of changes in question, and we could see resolutions soon, closer to the OEP. Agents should also be careful of how they educate clients on the 2025 ACA Final Rule changes and stay. There may be a fine balance to find between informing and not confusing clients even more.

We don’t have all the answers now, and there are not clear timelines on when we can expect Judge Hurson’s final ruling on the 2025 ACA Final Rule lawsuit or PTC conversations to come to a close. To stay up to date on ACA and Medicare news, we encourage you to subscribe to our blog and register with RitterIM.com. (It’s free!)