Recently, the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) released their Notice of Benefit and Payment Parameters (NBPP) for 2026 Proposed Rule. In it, CMS proposes new standards for health insurance marketplaces and agents.
The 2026 NBPP proposed rule aims to better protect clients, make affordable coverage more accessible, and encourage agents to act in their clients’ best interests.
Let’s examine the proposed changes agents need to be aware of before CMS announces the 2026 marketplace final rule.
Expanded Authority to Suspend Rogue Agents
One of the top concerns in the marketplace for 2024 has been unauthorized activity. A whopping 74,000 clients reported their coverage being changed without their consent earlier this year.
In short, rogue agents or marketing call centers were tricking clients into making changes to their Affordable Care Act (ACA) coverage without the knowledge of their current agent and without informing the client of their new coverages. CMS stepped into action and began monitoring accounts more closely for signs of fraud. They suspended or terminated agents who made alleged fraudulent actions, created safeguards for online enrollment platforms to prevent unauthorized switches from occurring, and imposed monetary penalties on agents who committed these fraudulent actions.
To continue deterring improper activities, for 2026, CMS would like to expand their authority to suspend marketplace agents and brokers if they determine that an agent is a risk to the marketplace. CMS is proposing policies related to compliance reviews and penalties against lead agents at insurance agencies to hold them responsible for marketplace violations.
Updated Agent Templates
CMS also plans to expand their model consent form, a template agents can use when creating their own forms. The updated forms would include scripts for agents to use while documenting client consent and authorization. They hope these updates increase transparency and reduce errors, saving costs associated with marketplace operations.
Ritter already has scripts and forms that agents can use with their clients to adhere to compliance standards. We will update these forms as necessary to meet future ACA documentation requirements.
ACA Consumer Marketplace Authorization Form
Use this form to easily and compliantly collect consumer authorization when completing marketplace enrollments.
Download NowACA Consumer Eligibility Application Attestation Call Script
Use this script to easily and compliantly collect consumer authorization over the phone.
Download NowACA Eligibility Application Attestation Form
We’ve created a form to help you collect ACA eligibility application attestations.
Download NowACA Consumer Eligibility Application Attestation Call Script
Use this call script to easily and compliantly collect marketplace clients’ eligibility application attestations.
Download NowStricter Limits on Silver Loading Practices
“Silver loading” occurs when carriers increase the premiums for Silver plans to offset the cost of providing cost-sharing reductions that minimize a client’s costs for deductibles and copays. CMS has presented that certain Silver loading practices are allowed when adjustments are reasonable, adequately justified, and follow state laws. They’re now seeking public comment on whether to codify their previous guidance. We will keep you informed if they announce more specific guidance that outlines these protections.
Two New Payment Thresholds for Carriers
CMS is proposing to allow issuers to implement one of the following premium payment maximums: permit fixed or premium-percent. These new capacities would allow clients to maintain their coverage, even if they have not paid the full amount they owe, if the amount paid does not exceed the premium payment threshold established by the carrier.
Currently, carriers may set a percentage-based net premium threshold, which allows clients to maintain their coverage even if they have paid their portion of their premium that is less than 100 percent. These new caps would reduce coverage gaps and prevent loss of coverage for clients who may be experiencing financial hardship. Historically, clients with lower incomes may have been placed into a grace period when they fail to pay their monthly premium, forcing them to make a full premium payment by the end of the month or lose coverage.
The new thresholds aim to increase client protections via three possible payment caps.
Source: Centers for Medicare & Medicaid Services, “HHS Notice of Benefit and Payment Parameters for 2026 Proposed Rule.”
Improving Plan Options and Benefits
Currently, CMS defines standardized plan options as qualified health plans (QHPs) that accept premium tax credits or subsidies and cover all essential health benefits. Carriers that operate in the federal marketplace are required to offer QHPs in every network, at every metal tier, and throughout every service area they offer coverage.
CMS is planning to update the plan options for 2026 to ensure that every plan matches the actuarial value assigned to the plan’s metal tier. They also are proposing to require issuers to offer multiple standardized plan options in each of the categories listed above. These protections would encourage clients to understand their benefits, network, and prescription coverage when selecting a plan during the Open Enrollment Period (OEP) or Special Enrollment Period (SEP).
As part of this effort to increase transparency and standardization in the marketplace, CMS plans to clarify whether the flexibility plans have to include coverage for adult dental, pediatric dental, and adult vision benefits in their non-standardized plan options.
Under the new proposed rules, plans would be required to cover over-the-counter contraceptives without requiring a prescription and without cost-sharing requirements. These new benefits could cover over-the-counter birth control, emergency contraception, condoms, folic acid supplements, and more. Any of the new proposed rules would not modify federal protections related to contraceptive coverage.
Extending Failure to File and Reconcile Notifications
The marketplace requires clients to file their federal income taxes and reconcile their premium tax credits. CMS proposes that marketplaces notify individuals who have failed to file their federal income taxes and reconcile their tax credits for two consecutive tax years that they are at risk of losing their premium tax credits. This notice will raise awareness of the policyholder’s need to file and reconcile their tax credits so they don’t lose out on vital subsidies.
Improve Public Reporting on State and Federal Marketplaces
While the ACA and marketplace continue to grow, CMS proposes new programs to increase transparency surrounding the market. This would include publicly releasing the annual State-based Marketplace Annual Reporting Tools and the financial and program audits and data points of state-based marketplaces. CMS aims to encourage public trust and knowledge about the marketplace, ensure compliance, and improve efficiency.
CMS aims to enhance consumer protections with the new NBPP. All these marketplace proposed rules are not final, but they’re important for agents to be aware of. We’ll continue to monitor the marketplace and inform agents on significant changes regarding the 2026 Marketplace final rule.
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