On February 9, the Centers for Medicare & Medicaid Services (CMS) issued the Plan Year (PY) 2027 Notice of Benefit and Payment Parameter (NBPP) Proposed Rule — an annual rule to update policies governing the Affordable Care Act (ACA) exchange plans and risk adjustment program for the next plan year. Among other changes, the rule includes updates needed to align regulations with changes in H.R. 1, also known as the "One Big Beautiful Bill Act" (OBBBA), and builds on changes finalized in the 2025 Marketplace Integrity and Affordability rule. If finalized, the proposed rule would make substantial changes to ACA exchange plan eligibility rules, benefit designs, verification requirements, marketing practices, and more. CMS in the rule also requests comment on other potential changes to the medical loss ratio standard and implementation of pre-eligibility verification requirements under the OBBBA.

"We are cracking down on improper and misleading practices while giving states and health plans more room to innovate and compete," CMS Administrator Mehmet Oz said in a statement.

CMS in the proposed rule estimates the changes would lower average enrollment in exchange plans by up to 2 million people for 2027. CMS says it expects healthier enrollees will make up the bulk of the coverage losses and estimates that would increase premiums for 2027 by up to 3%. However, CMS says it expects proposed changes would improve the health of the risk pool and result in a net premium reduction of up to 1.8% for 2027. The rule is open for public comment through March 13.

Press release, Fact sheet, Proposed rule

Additional information is available in the WCEY Health Alert, attached below.