By: HUB’s EB Compliance Team

On February 9, 2026, the U.S. Department of Health and Human Services (“HHS”), through the Centers for Medicare & Medicaid Services (“CMS”), released its proposed “Notice of Benefit and Payment Parameters” for the 2027 plan year. Although CMS releases this rule every year, this particular proposal is significant, as it includes major structural changes to insurance design and provider network regulations. 

Every year this rule sets standards for the health insurance marketplaces, as well as for the issuers, brokers and agents who assist marketplace enrollees in finding Affordable Care Act (“ACA”) coverage. The rule contains provisions that aim to improve implementation of the ACA by setting standards for federal and state ACA exchanges. The 2027 proposed rule can be found in the Federal Register here. 

New Types of Qualified Health Plans (“QHPs”)

The new proposed rule would allow CMS, beginning in plan year 2027, to certify non-network or non-traditional health plans as qualified health plans. QHPs can offer minimum essential coverage under the ACA, but traditionally had to use a contracted provider network. Starting in 2027, non-network plans can receive QHP certification by demonstrating that they provide access to a sufficient choice of providers that accept the plan’s benefit amount as payment in full, and ensure that all services will be accessible without unreasonable delay. The new arrangement opens a door for Direct Primary Care (“DPC”) models and the use of reference-based payment structures. 

Per CMS’ summary of the rule, this feature aims to reduce overall health care costs by “(1) empowering enrollees to utilize price transparency information to shop for lower prices and negotiate directly with providers, thus fostering increased competition, and (2) eliminating substantial administrative overhead associates with traditional network management, potentially resulting in lower premiums.” 

Other Highlights of the Proposed Rule

In addition to the broadened access to QHP status noted above, the proposed rule would also:

  • Allow issuers to offer catastrophic plans with terms of either one year or multiple consecutive years up to 10 years
  • Repeal the standardized plan options and limit requirements, giving issuers more flexibility to design plans
  • Expand hardship exemptions for certain individuals age 30 and older
  • Allow states to establish a new exchange option known as a State Exchange Direct Enrollment option which allows a state to offer its consumer-facing website through an HHS-approved web broker
  • Tighten Medicare Advantage payments by allowing for a minimal increase, as well as introducing new efforts to curb overpayments by refining how risk is measured

Takeaways

For employers that offer benefit options that rely on exchange coverage or exchange coverage definitions, the features of this proposed rule may serve to expand the types of plans an individual can find on any said exchange. For interested parties, please note that CMS is accepting comments on this proposed rule for 30 days after publication in the Federal Register, or until March 11, 2026.

If you have any questions, please contact your HUB Advisor. View more compliance articles in our Compliance Directory

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Neither Hub International Limited nor any of its affiliated companies is a law or accounting firm, and therefore they cannot provide legal or tax advice. The information herein is provided for general information only, and is not intended to constitute legal or tax advice as to an organization’s or individual's specific circumstances. It is based on Hub International's understanding of the law as it exists on the date of this publication. Subsequent developments may result in this information becoming outdated or incorrect and Hub International does not have an obligation to update this information. You should consult an attorney, accountant, or other legal or tax professional regarding the application of the general information provided here to your organization’s specific situation in light of your or your organization’s particular needs.