Proposed guidelines for operating Obamacare insurance exchanges in 2026 call for tightening protections against unauthorized actions by agents and brokers who help consumers enroll in coverage.
The proposal, released Friday by the Centers for Medicare & Medicaid Services, sets standards for health insurers and ACA marketplaces, as well as requirements for agents, brokers, and others who help consumers enroll in marketplace coverage. It also includes policies that affect Medicaid, the Children’s Health Insurance Program, and the Basic Health Program.
The 2026 Benefit and Payment Parameters proposed rule (RIN 0938-AV41) includes a number of proposals, including ways to prevent unauthorized marketplace activity by agents and brokers; standards for allowable “Silver Loading,” the raising of premiums for silver plans to offset the cost of providing cost-sharing reductions; and advancing health equity and mitigating health disparities.
“Our goal with these proposed requirements is providing quality, affordable coverage to consumers while minimizing administrative burden and ensuring program integrity,” the proposed rule’s preamble said.
The CMS proposes to expand its authority to suspend an agent or broker’s ability to transact information with the marketplace “if we discover circumstances that pose an unacceptable risk to the accuracy of Marketplace eligibility determinations, operations, applicants, and or enrollees,” said a CMS fact sheet.
The proposal is designed to improve marketplace security and integrity, and reduce unauthorized changes to coverage.
The proposal would also update the consumer consent form used by agents and brokers when assisting people with their marketplace enrollments and eligibility applications.
The expanded form would better document “that a consumer or their authorized representative reviewed and confirmed the accuracy of their eligibility application information before their application was submitted to the Marketplace,” the fact sheet said.
Boosting Accountability
The proposals are designed to “increase transparency and accountability in the application and enrollment process, help ensure that Marketplace application information is accurate, and reduce the risk of financial errors, such as receiving an incorrect advance payment of the premium tax credit (APTC) amount that would need to be repaid during tax reconciliation, or enrollment in health care coverage without a consumer’s consent” the fact sheet said.
The agency is also moving to update standardized plan options for 2026 by “requiring issuers to offer multiple standardized plan options within the same product network type, metal level, and service area to better differentiate these plans from one another to reduce the risk of duplicative offerings,” the fact sheet said.
This is designed to help consumers “better understand included benefits, networks, and drug coverage when making plan selections and comparisons,” the fact sheet said.
The proposed rule comes after a record 21.3 million people signed up for 2024 individual marketplace coverage under the Affordable Care Act.
The proposal sets standards for health insurers and ACA marketplaces, as well as requirements for agents, brokers, and others who help consumers enroll in marketplace coverage. It also includes policies that affect Medicaid, the Children’s Health Insurance Program, and the Basic Health Program.
Coverage sign-ups during the 2024 open enrollment period increased 31%—up 5.1 million people—compared with 2023.
About 25%, or 5.2 million, of the 21 million Obamacare enrollees in 2024 are first-time plan members. That’s up 41% from 3.7 million during the previous year’s open enrollment period. Overall, 80% of federal HealthCare.gov customers could chose coverage options that were $10 or less per month, according to the Department of Health and Human Services.