HHS Publishes 2027 Marketplace Proposed Rule

On Feb. 11, the Department of Health and Human Services (HHS) published the Notice of Benefit and Payment Parameters for 2027 (2027 NBPP), which sets standards for the health insurance marketplaces. The proposed rule includes provisions on essential community providers (ECPs), catastrophic plans, and non-network health plans. It also implements several provisions from the Working Families Tax Cut legislation (WFTCL).

The rule decreases the minimum percentage of ECPs required to be in-network for qualified health plans from 35% to 20%, which includes inpatient hospitals. The rule also would allow states on the federal exchange to conduct their own ECP reviews.

The rule expands the catastrophic plan term to either one year or multiple consecutive years not to exceed 10 years. Catastrophic plans with terms of at least two years may use value-based insurance designs to offer preventive services without requiring the beneficiary to satisfy their deductible or annual cost-sharing limitation.

The 2027 NBPP proposes to certify non-network plans as qualified health plans. Non-network plans set specific benefit amounts for covered services and share those amounts with enrollees, allowing them to compare providers' prices. Non-network plans would be required to ensure access to providers that accept the plan's benefit amount as payment in full, including ECPs.

The rule also implements several marketplace-related provisions in the WFTCL, including extending the removal of the 150% federal poverty level special enrollment period, limiting advance premium tax credit (APTC) eligibility to "eligible noncitizens," and ruling immigrants ineligible for Medicaid ineligible for APTCs.

Comments are due March 13.

Contact Director of Policy Rob Nelb, MPH, at [email protected] or 202.585.0127 with questions.