❓WHAT HAPPENED: The Centers for Medicare & Medicaid Services (CMS) proposed new regulations for 2027 aimed at cutting health care costs, expanding consumer options, and cracking down on fraud.
👤WHO WAS INVOLVED: CMS, insurers, agents, brokers, and U.S. taxpayers.
📍WHEN & WHERE: Proposed regulations for 2027, with public comments open until March 11, 2026.
💬KEY QUOTE: “We are cracking down on improper and misleading practices while giving states and health plans more room to innovate and compete.” – Dr. Mehmet Oz, CMS Administrator
🎯IMPACT: Potentially lower health care costs, expanded plan options, and stricter fraud prevention measures.
The Centers for Medicare & Medicaid Services (CMS) has proposed regulations for 2027 to further reduce health care costs while giving consumers more choices. The plan also focuses on safeguarding taxpayer dollars by strengthening efforts to combat fraud, reduce improper enrollments, tighten verification procedures, and ensure that subsidies are provided only to those who qualify.
One major element of the proposal would give insurers greater flexibility in designing health plans. CMS is considering allowing catastrophic plans to extend for as long as 10 years, removing standardized plan requirements to encourage innovation, and broadening hardship exemptions so more individuals can qualify for catastrophic coverage.
CMS also proposes allowing some plans that rely on non-network providers to count as Qualified Health Plans (QHPs), provided enrollees still have adequate access to providers. At the same time, the agency would impose tougher standards on agents and brokers to address misleading marketing and unauthorized changes to consumer coverage.
Additional provisions would strengthen income and eligibility verification for subsidies, align subsidy eligibility with federal immigration law by excluding certain lawfully present immigrants, and reinstate state oversight of provider networks and access to Essential Community Providers (ECPs).
CMS Administrator Dr. Mehmet Oz highlighted the balance the agency is aiming to strike, saying, “We are cracking down on improper and misleading practices while giving states and health plans more room to innovate and compete.” CMS will accept public comments on the proposed rules through March 11, 2026, before finalizing regulations for implementation in 2027.
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