The Centers for Medicare and Medicaid Services (CMS) have finalized a rule that imposes new standards for the Affordable Care Act (ACA) individual market for the federal and state exchanges in 2026.
The rule is meant as a consumer protection, preventing policy coverage from being swapped without authorization from the policy beneficiary and imposes strict consequences on brokers or agents that violate the rule, Fierce Healthcare reports. It also amends the risk adjustment program through new calculations to the Basic Health Program and ACA Quality Improvement Strategy. Cost-sharing reduction loading will be allowed if “actuarily justifiable,” and CMS said that it is seeking comments on how health plans can offer non-standardized plans.
This includes plans offered under the non-standardized plan option limit exceptions process that facilitate the treatment of chronic and high-cost conditions, which could play an important role in combatting health disparities and advancing health equity.
Read the fact sheet on the final rule from CMS
The final rule can be reviewed in full at the Federal Register.
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