WASHINGTON, D.C. — The Centers for Medicare & Medicaid Services (CMS) has issued a final rule designed to reduce individual health insurance premiums and combat improper enrollments in the Affordable Care Act (ACA) Exchanges. The Marketplace Integrity and Affordability Final Rule is projected to lower premiums by approximately 5% on average and save taxpayers up to $12 billion in 2026 by addressing inefficiencies and ensuring proper allocation of federal funds.
“We are strengthening health insurance markets for American families and protecting taxpayer dollars from waste, fraud, and abuse,” said U.S. Health and Human Services Secretary Robert F. Kennedy, Jr.
The final rule introduces several key reforms aimed at stabilizing the ACA marketplaces. Among the most significant changes are enhanced income verification processes, mandatory pre-enrollment eligibility checks for special enrollment periods (SEPs), and adjustments to premium subsidies for automatically re-enrolled individuals. By instituting these measures, CMS seeks to improve the risk pool and enhance consumer engagement, which can help reduce costs for middle-class families not receiving subsidies.
Other finalized policies include repealing the monthly SEP for individuals with household incomes under 150% of the federal poverty level, a move aimed at curbing unauthorized enrollments. Additionally, CMS will standardize the annual open enrollment period starting in 2027, requiring it to conclude by December 31, a measure intended to promote continuous coverage and reduce adverse selection.
To ensure proper use of federal subsidies, the rule prohibits the funding of certain procedures under essential health benefit requirements and excludes Deferred Action for Childhood Arrivals (DACA) recipients from eligibility for ACA coverage and associated subsidies.
The policy changes, many of which will sunset at the end of the 2026 plan year, align with CMS’s broader goal of reducing waste and improving affordability while maintaining access to quality healthcare for qualified individuals.
“These reforms represent a commitment to fiscal discipline and marketplace stability while ensuring coverage is there for those who truly need it,” said CMS Administrator Dr. Mehmet Oz.
The rule aims to help restore accountability and promote sustainable, equitable healthcare reform. It is said to be a key step in addressing issues that have challenged the ACA marketplaces in recent years. The final rule can be downloaded from the Federal Register,
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