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CMS Finalizes ACA Exchange Overhaul, Expands Catastrophic and Non‑Network Plans

Higher premiums and deductibles are already pushing millions off marketplace coverage.

Overview

  • CMS, which finalized the rule Friday for 2027 coverage years, said the changes will broaden lower‑premium options and tighten eligibility checks to curb improper enrollments.
  • The rule lets people remain in catastrophic plans for up to 10 years and widens hardship access so more uninsured consumers can use this bare‑bones coverage when incomes shift.
  • Regulators scrapped standardized plan designs and caps on nonstandard options, and they will allow approved non‑network plans to sell on exchanges starting in 2028.
  • KFF said Tuesday the average marketplace deductible jumped 37% to $3,786 in 2026 as many enrollees moved from silver plans to lower‑premium bronze coverage, which reached 40% of selections.
  • KFF projects effectuated enrollment could drop by roughly 5 million to about 17.5 million this year as average monthly payments after subsidies rose 58% to $178, and providers warn looser guardrails could leave patients with big bills and hospitals with more uncompensated care.