On June 25, 2025, the U.S. Department of Health and Human Services (HHS) finalized new Affordable Care Act (ACA) Marketplace standards aimed at reducing fraud from improper enrollments, strengthening verification, and balancing affordability with fiscal responsibility.
Key Changes
Most changes take effect August 25, 2025, with some provisions starting later or expiring after the 2026 plan year. Key updates include:
- Ending the monthly special enrollment period for individuals with incomes below 150% of the federal poverty level after the 2026 plan year;
- Starting in 2027, the annual open enrollment for individual coverage will run from November 1 to December 31 (up to nine weeks), with federal platform Exchanges holding enrollment from November 1 to December 15;
- Ending eligibility for Deferred Action for Childhood Arrivals (DACA) recipients.
- Individuals who do not file and reconcile their federal tax return will be ineligible for the advance premium tax credit (APTC) (effective for 2026 only);
- Insurers may require payment of past-due premiums before starting new coverage, as allowed by state law;
- Individuals auto-renewed into no-premium federal Exchange plans must pay $5 per month until their eligibility details are confirmed (effective for 2026 only); and
- Non-grandfathered individual and small group plans cannot cover specified sex-trait modification procedures as essential health benefits (effective beginning with the 2026 plan year).
Impact on Employers
These changes may make Exchange enrollment more difficult for employees to enroll in Exchange coverage. Employers that offer individual coverage health reimbursement arrangements (ICHRAs) may find this problematic, while employers subject to the ACA’s employer shared responsibility penalties (“pay-or-play” penalties) may reduce their penalty risk if fewer employees enroll in Exchange coverage. Download the bulletin for more details.
