The Centers for Medicare and Medicaid Services wants to take a firmer hand against health insurance marketers that fraudulenty switch exchange enrollees' plans without their consent.
On Friday, the agency issued a proposed rule updating the regulations that govern the health insurance exchange marketplaces next year, including provisions to strengthen its authority to suspend dishonest agents and brokers and to prevent low-income people from losing coverage when they fall behind on premium payments.
Related: CMS limits ACA broker access to thwart rogue sign-ups
As part of the marketing elements of the proposed rule, CMS aims to ensure that exchange enrollees consent to policy changes and keep their personal information up to date by updating an existing form.
To help members retain plans when they are in arrears to insurers, CMS proposes requiring health insurance companies to keep customers who owe money if the amount is below $5 or a different threshold based on a percentage of their premiums.
The proposed rule also would update the risk-adjustment program for exchange plans by recalibrating the model with more recent data and changing how it samples the claims it uses for audits.
Other provisions of the 2026 Notice of Benefit and Payment Parameters proposed rule include:
- Requiring health insurers to review networks to ensure there are enough Essential Community Providers that treat low-income and other underserved patients.
- Requiring exchanges to notify enrollees that they could lose subsidies if they fail to file federal tax returns.
- Tweaking the benefits required for standardized bronze, silver, gold and platinum plans.
- Requiring insurers to offer multiple standardized plans within the same product types, metal levels and service areas.
- Publicly posting audits of state exchanges and state-based exchanges that use the federal enrollment platform.
- Increasing the user fee to 2.5% of premiums on the federal exchanges and to 2% on state exchanges that use the federal enrollment platform.
CMS will accept public comments on the proposed rule until Nov. 12.