CMS Proposes Major Changes to ACA Plans

February 17, 2026

CMS has issued proposed regulations that would change requirements for insurers offering coverage on the federal health insurance marketplace and state marketplaces like Pennie.

Here’s what you need to know:

• Key changes:  CMS is proposing to allow issuers on the individual marketplace to offer catastrophic plans with terms of either one year or multiple consecutive years (up to 10 years). They are also proposing to:
  • Repeal standardized plan options and related limit requirements.
  • Permit low-deductible plans with higher maximum out-of-pocket limits options.
  • Expand hardship exemptions for certain individuals age 30 and older.
• Income verification:  The rule also includes the reintroduction of a requirement for consumers to submit documents to verify their income when data sources indicate household income is under 100 percent of the federal poverty lines.
  • It also removes the requirement for exchanges to accept a household’s income attestation when IRS returns no data for the household.
• Auditing the program:  It also clarifies the government’s rule to audit or conduct a compliance review of an issuer offering a health plan through the exchange.
• Next steps:  The agency is accepting public comments on the changes through March 13.
• Quotable:  “This proposed rule lowers premiums, expands consumer choice, cracks down on fraud, and promotes innovative coverage that prioritizes prevention and long-term health,” said Dr. Mehmet Oz, CMS administrator, in a statement.

Additional details are available online.