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CMS to crack down on ACA plan marketing, tighten income verifications

The proposed notice of benefit and payment parameters for 2027 would tighten marketing for ACA plans and income verification rules for consumers seeking assistance with marketplace coverage.

Jacqueline LaPointe
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Published: 10 Feb 2026

CMS has proposed 2027 benefit and payment parameters for health insurance marketplaces, including plan issuers and brokers who assist marketplace enrollees. The proposed rule released on Monday seeks to crack down on healthcare fraud and abuse, including misleading practices by agents and brokers.

In the rule, CMS recommended stronger regulations on marketing practices for qualified health plans participating in the Affordable Care Act's health insurance exchanges, as well as agents, brokers and web brokers that assist with enrollment in qualified health plans. The rule would prohibit practices, including providing cash, monetary rebates and other cash equivalents to induce enrollment.

CMS also seeks to stop misleading marketing tactics that suggest consumers will qualify for zero-dollar insurance or zero-dollar premiums. Qualified health plans, agents and brokers would also face consequences for miscommunicating enrollment deadlines.

Notably, the rule would ban the use of AI-generated images and videos for endorsements by notable figures, such as celebrities or politicians. Specifically, CMS called out the use of AI to attribute quotes to public figures when they did not actually speak the words in the advertisements.

These actions are part of the Trump administration's focus on improving program integrity. The proposed rule also seeks to create standard application review and consumer consent forms, as well as implement a program to measure improper payments of advance payments of the premium tax credit.

"This proposal puts patients, taxpayers, and states first by lowering costs and reinforcing accountability for taxpayer dollars," CMS Administrator Dr. Mehmet Oz said in an announcement on Monday. "We are cracking down on improper and misleading practices while giving states and health plans more room to innovate and compete. The goal is simple: lower costs, more choice, and Exchanges that work as intended."

Aligning with the One Big Beautiful Bill Act provisions

In addition to cracking down on healthcare fraud, the proposed rule would implement key provisions in Public Law 119-21, known as the One Big Beautiful Bill Act, and align with the law's marketplace reforms.

Specifically, CMS proposed stricter income verification rules next year for those enrolling in marketplace plans. The rule would expand a requirement for low-income consumers, who would need to verify their income if data sources indicate household income below 100% of the federal poverty line.

The rule would also continue a policy to remove the requirement for exchanges to accept a household's income attestation when the IRS does not have data for the household.

Also, in alignment with the One Big Beautiful Bill Act, the proposed rule seeks to disallow advanced premium tax credits for consumers who are ineligible for Medicaid due to their immigration status and are expected to have an annual household income below 100% of the federal poverty line.

Additionally, the proposed rule recommends limiting eligibility for advanced premium tax credits to "eligible aliens," requiring exchanges to verify consumer status.

Other key proposals for 2027 benefit, payment parameters

The sweeping 577-page proposed rule also included key benefit and payment parameters related to plan design and affordability. Notably, the proposed rule seeks to help consumers more easily enroll in catastrophic plans, allowing issuers to offer plans with terms of up to 10 years. These plans are generally cheap but have very high deductibles.

CMS also seeks to repeal standardized plan options and related limit requirements. The federal agency intends to give plan issuers more flexibility to design plans that meet consumer demands, including lower deductibles. States would also be able to establish new exchange options if the proposed rule is finalized as is. These would be known as State Exchange Direct Enrollment options.

Additionally, CMS wants to certify non-network health plans as qualified health plans in 2027. These plans would have to demonstrate sufficient choice of providers within their networks per Affordable Care Act guidelines.

CMS will accept comments on the proposed rule through March 11.

Jacqueline LaPointe is a graduate of Brandeis University and King's College London. She has been writing about healthcare finance and revenue cycle management since 2016.

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