For agent use only. This information is subject to change.
The Centers for Medicare & Medicaid Services (CMS) just released the HHS Notice of Benefit and Payment Parameters for the 2027 plan year. This proposed rule lays out significant changes to how ACA marketplace plans are regulated and administered.
The proposal touches on everything from agent marketing standards to eligibility verification, plan options, and documentation requirements – and it could mean significant changes lie ahead for how insurance agents operate, and how consumers shop for and enroll in coverage.
While the rule is still under review, it offers a clear look at where federal ACA oversight is headed. In this post, we’ll unpack the key elements of the proposal and what they could mean for you and your clients.
Stronger Marketing Standards and Compliance Oversight
One of the most notable components of the 2027 proposed rule is the expansion of marketing regulations for agents.
Under the proposal, CMS would prohibit agents from marketing ACA health plans using:
- Cash incentives or rebates
- Misleading or false information
- Carrier or government logos
- $0-premium messaging
- Misrepresenting enrollment or coverage timelines
- Unauthorized images, including AI-generated deep fakes
Agents would also be required to provide marketing materials to CMS upon request, making documentation and record-keeping more important. Enhanced penalties for bad-faith advertising are also on the table.
For agents: Compliance will need to be a top priority. Agents may need to revise scripts, revisit websites, and make sure all materials align with set standards. Contact our team anytime to review your materials – we can help ensure compliance is met.
For clients: These changes aim to protect them from misleading claims and improper influences – hopefully leading to a more transparent and trustworthy interaction with agents.
CMS-Approved Consent Forms and Enrollment Documentation
CMS has concerns over incomplete or inaccurate agent-collected enrollment forms. As a result, the proposed rule may require agents to use CMS-approved client consent forms and call scripts when gathering enrollment data.
Although this is not yet mandatory, CMS has released a model client consent form for agents to use, and the final rule could make this standard practice.
Impacts:
- Agents should integrate consent forms and approved scripts into their workflows now to prepare
- Accurate, compliant documents could reduce rejected applications and compliance risk
Expand Enforcement Authority over Agents
The rule also seeks to expand CMS’s authority to take administrative action against agents who engage in fraud or misconduct. This includes the ability to audit agent activity, restrict appointments, and impose civil penalties.
Why? This increased oversight is CMS’s intent to decrease deceptive practices and increase professionalism within ACA markets.
Requiring Verification for Special Enrollment Periods (SEPs)
CMS is proposing that the federal exchange be responsible for at least 75 percent of enrollments before coverage can be finalized.
This could slow processing times and add documentation steps for clients – particularly for life changes like job loss, marriage, or moving. Agents should aim to collect full supporting materials early in the enrollment process to avoid delays.
Documentation Requirements for Income Verificaiton
CMS is proposing additional documentation requirements for those whose income falls below 100% of the Federal Poverty Line (FPL) to ensure eligible clients receive coverage.
Rather than relying on self-attestation, CMS may require W-2’s, pay stubs, or IRS data to prove income levels. Agents may need to assist clients in submitting this information.
Changes in Plan Design and Marketplace Options
The proposed rule would also eliminate standardized plan options, remove the caps on non-standardized plans carriers could offer, and give carriers greater flexibility in plan design and offerings.
A wider variety of plan designs could make it harder for clients to compare side by side. As a result, there would be a greater need for agent expertise in helping clients understand their coverage options, cost-sharing, and provider access.
Other Notable Proposed Changes
Removing Dental Benfits from Plans
The proposed rule would prohibit ACA plans from offering dental benefits for both adults and children. Dental coverage would become an optional add-on for ACA plans. It’s a good idea to include a strong dental plan in your portfolio so you’re prepared if this proposal becomes law.
Citizenship and Subsidy Eligibiltiy
CMS may refine the definition of “eligible noncitizens”, which could reduce subsidy eligibility for certain groups. If you are an agent serving diverse populations, this is something to monitor.
Removal of the 150 Percent FPL SEP
The proposed rule would eliminate the 150 percent FPL SEP after PY 2026. Lower-earning clients would not be able to enroll in marketplace coverage year-round if their income falls beow 150% of the FPL.
Expanded Hardship & Catastrophic Plan Options
Individuals 30 and older who lose subsidy eligibility due to income changes could qualify for expanded catastrophic plan options, potentially making them eligible for low-premium, high-deductible plans accessible for longer durations and more years.
Prepare Now for What’s to Come
While the 2027 ACA proposed rule is not final, it signals several major shifts – including everything from increased marketing compliance standards for agents, to expanded verification requirements and more complex plan options for clients.
Agents who prepare now by updating workflows, strengthening compliance, and enhancing client education will be better positioned to thrive in what’s to come of the ACA marketplace.
The public comment period lasts through March 11, 2026. CMS will review feedback before issuing a final rule, and we will provide updates as they come.
For agent use only. This information is subject to change
Resources & Further Information
HHS Notice of Benefit and Payment Parameters for 2027 Proposed Rule Fact Sheet
CMS Proposes Regulations to Lower Health Care Costs, Expand Consumer Choice, and Protect Taxpayers
