(July 3, 2025) - On June 20, 2025, CMS released the ACA Marketplace Integrity and Affordability Final Rule. Key provisions include:
• Revised procedures for stricter income verification and eligibility redetermination procedures
• Changes to the open enrollment period
• Implementing pre-enrollment verification for special enrollment periods
These provisions are expected to reduce enrollment in Marketplace plans. CMS estimates 725,000 to 1.8 million people may lose coverage. Additionally, these provisions are finalized in light of the reconciliation bill pending Congress that contemplates similar changes to Marketplace enrollment and coverage. The CMS Newsroom provided the following summary.
The rule is effective August 25, 2025.
--Shannan Flach