CMS releases final rule on Marketplace Integrity and Affordability

The Centers for Medicare & Medicaid Services June 20 announced it is finalizing its 2025 Marketplace Integrity and Affordability final rule. The rule shortens the open enrollment period for the federal marketplace to Nov. 1-Dec. 15 starting in 2027, and limits open enrollment periods for state-based marketplaces to Nov. 1-Dec. 31. The rule also includes a change to the premium adjustment percentage that would increase the maximum annual cost sharing limitation. Additionally, the rule makes updates to the income verification process and pre-enrollment verification process for special enrollment periods, changes to the essential health benefits, modifications to the redetermination and re-enrollment processes, and ends a SEP for low-income individuals, among other policies. Many of the provisions reinstate policies finalized during the prior Trump administration.

The AHA in April expressed concerns to CMS after the rule was proposed. CMS had estimated that 750,000 to 2 million consumers could lose their coverage due to the provisions. The AHA encouraged CMS to pause finalizing many of the proposals to give it and stakeholders additional time to consider the impacts while also taking action to stop brokers responsible for inappropriate enrollments.