On May 15, 2026, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), released the final “Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program” (2027 Payment Notice final rule). CMS published a press release and a fact sheet summarizing major provisions of the 2027 Payment Notice final rule.
The Payment Notice final rule is an annual rule implementing aspects of the Affordable Care Act for issuers offering qualified health plans (QHPs) through Exchanges. The 2027 Payment Notice final rule also includes updates to align regulations with changes made in the Working Families Tax Cut (WFTC) legislation.
Key highlights of the 2027 Payment Notice final rule:
- Beginning immediately (30 days after publishing in the Federal Register):
- Issuers that intend to load rates to account for unpaid cost sharing reductions (CSRs) for the applicable rating year are required to submit certain information related to CSR loading in their Unified Rate Review Templates (URRTs) and the Actuarial Memoranda for each filing year in which CSRs are not funded beginning with plan year 2027 rate filings.
- CMS finalized clarifications with respect to issuing civil money penalties (CMPs), noting that it will identify the lawful purpose of the penalty. CMS also finalized clarifications related to netting payments owed to issuers and their affiliates under the same tax identification number against certain payments and CMPs owed to the Federal government.
- Beginning plan year 2027:
- Issuers are prohibited from including routine non-pediatric dental services as EHB.
- Catastrophic plans may be offered for a term of either one year or multiple consecutive years up to 10 years.
- Issuers using HealthCare.gov are no longer required to offer standardized plan options and there are no longer limitations on the number of non-standardized plan options issuers can offer.
- If an issuer offers a bronze plan in the individual market that complies with the cost-sharing and the levels of coverage requirements, it may also offer, within the same service area, bronze plans that utilize a cost-sharing design that exceeds the maximum annual limitation on cost sharing.
- Beginning plan year 2028:
- State-required benefits would be considered “in addition to EHB” if States have added such benefits since December 31, 2011.
- Non-network plans may be certified as QHPs on the FFE. SBEs or SBE-FPs may allow these plans beginning in plan year 2027.
- Catastrophic plans must not provide coverage for benefits for any plan year until an amount equal to 130 percent of the maximum annual limitation on cost sharing is reached.
The final rule also finalizes changes to eligibility verification in line with WFTC, and increases oversight of agents and brokers. Groom will be publishing a summary of the final rule. For additional questions about these or any other policies included in the final rule, please contact any of the authors or your Groom attorney.
"The Centers for Medicare & Medicaid Services (CMS) issued a sweeping rule to strengthen oversight of the Affordable Care Act (ACA) Exchanges for plan year 2027 by lowering user fees, tightening eligibility verification, and giving states greater authority over plan oversight." CMS Press Release, May 15, 2026.
