3 Ways ACA Marketplaces will Change in 2027 and Beyond

May 18, 2026

Plans on Affordable Care Act (ACA) marketplaces are changing in 2027.

Last week, CMS published a final rule for plan year 2027 with some notable updates related to catastrophic coverage, essential health benefits, and special enrollment periods.

Background

This year, nearly 500,000 Pennsylvanians selected health insurance coverage via the Pennie individual marketplace. There were 23 million plan selections across the federal marketplace and other state-based exchanges.

Here are few things to know:

1. Catastrophic plans

People across the U.S. who don’t qualify for advanced premium tax credits due to income (below 100 percent or above 250 percent of the federal poverty line) can qualify for an exemption to enroll in catastrophic coverage when they have a change in income.

CMS will allow these low-premium, high-deductible catastrophic plans to have terms of multiple consecutive plan years, up to 10 years.

“Multi-year catastrophic plans will also be allowed to provide pre-deductible coverage through value-based insurance designs that incentivize consumers to receive higher-value services at lower cost, pursuant to guidelines issued by HHS and the Departments of Labor and the Treasury,” the agency said in a fact sheet.

The agency is also adding new cost-sharing parameters to “increase flexibility for issuers designing individual market bronze (2027) and catastrophic plans (2028).”

2. Essential health benefits

Starting in 2028, states will be required to offset the costs for any additional benefits they require beyond the ACA’s outlined essential health benefits (EHB).

CMS is finalizing a policy to prohibit issuers from including routine non-pediatric dental services as an EHB. Federal officials said the change is to ensure “the scope of EHB be equal to the scope of benefits provided under a typical employer plan.”

3. Special enrollment periods

The rule extends the prohibition of special enrollment periods for households at 150 percent of the federal poverty level, reducing “opportunities for unauthorized enrollments and unauthorized plan switching,” the agency said.

It also reinstates pre-enrollment verification for Special Enrollment Periods on the federal health insurance exchange.

Additional information about these changes is available online in this fact sheet.