Today, the Biden-Harris Administration, through the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS), announced policies for the Affordable Care Act marketplaces that they make it easier for low-income people to sign up for coverage. , gives states the ability to increase access to routine dental services for adults and sets network adequacy standards for the time and distance people travel for appointments with network providers. Finally, the rule will standardize certain transactions in the marketplaces to increase reliability and consistency for consumers. .The 2025 Notice of Benefits and Payment Parameters final rule builds on the Administrations’ previous work to expand access to quality, affordable health care and to raise the standards of Marketplace plans nationally .
More than 21 million Americans signed up for high-quality, affordable health coverage through the ACA’s marketplaces by 2024. We want to build on this success to further improve marketplace plans, the secretary said from HHS, Xavier Becerra. This rule will allow coverage of routine dental benefits for the first time, expand requirements to ensure reliable access to health care providers, and ensure that lower-income consumers can sign up for coverage when they need it.
Access to affordable, quality health care options remains a concern across the country and a top priority for CMS, said CMS Administrator Chiquita Brooks-LaSure. This rule includes innovative ways to access health care services, including addressing barriers to routine dental coverage for adults for the first time and including considerations for how far people travel to see a health care provider . At CMS, we continue to explore ways to help Americans access high-quality coverage through the ACA marketplaces.
Increase access to health services
Dental services for adults
CMS has expanded access to dental benefits by finalizing measures to allow states the option to add routine dental services for adults as an essential health benefit (EHB). For the first time, and starting January 1, 2027, all states will be able to update their EHB referral plans to include routine non-pediatric dental services such as cleanings, diagnostic X-rays and restorative services such as fillings and root canals . channels, through the EHB reference application process from 2025 onwards.
Adequacy of the network
The final rule creates more consistent national standards for how far and how long a consumer must travel to see various types of providers in state marketplaces and state marketplaces on the federal platform (SBM-FP). State marketplaces and state marketplaces must review information from a plan network before certifying any plan as a qualified health plan (QHP), consistent with reviews conducted by the Federal Facilitation Marketplaces (FFM).
Making it easier to sign up for coverage
Special enrollment periods
The rule extends the Special Enrollment Period (SEP) for consumers with household incomes at or below 150% of the FPL (for plan year 2025, $38,730 for a family of three) to enroll in the coverage in any month instead of just during open enrollment. . Previously, this SEP was only available when there were enhanced grants under the IRA.
The rule also aligns the dates of open enrollment periods in nearly all markets to generally begin on November 1 and end no earlier than January 15, with the option to extend the open enrollment period beyond of January 15.
In addition, the rule aims to avoid coverage gaps for those who transition between different markets or from other insurance coverage by allowing those who select coverage during certain SEPs to receive coverage from the first day of the month following QHP selection, as opposed to coverage beginning on a later date if the consumer enrolls between the 15th and the end of the month.
Streamline the registration processThis rule includes several policies to standardize operations between federally and state-facilitated marketplaces to ensure a more streamlined consumer experience, such as requiring marketplaces to have live call center representatives available during the center’s hours of operation. calls to help consumers with QHP applications. and enrollment, generally holding open enrollment from November 1 to January 15 (with Marketplaces’ option to extend open enrollment to a later date), and automatically re-enroll enrollees in a catastrophic plan for next year, in order to avoid gaps in coverage.
For more information on the final rule, see the fact sheet at https://www.cms.gov/newsroom/fact-sheets/hhs-notice-benefit-and-payment-parameters-2025-final-rule
Click here to view the final rule: https://www.cms.gov/files/document/cms-9895-f-patient-protection-final.pdf
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