In July 2025, the Centers for Medicare & Medicaid Services (CMS) finalized new rules for the Affordable Care Act (ACA) Marketplaces. These changes aim to improve the program’s integrity, reduce fraud, and ensure that only those who truly qualify receive subsidies.
Most of the new rules will take effect in the 2026 coverage year. These rules will change how subsidies are granted, how re-enrollment works, and how special enrollment periods (SEPs) are handled.
🗓️ Quick Breakdown of Federal ACA Rule Changes (Effective 2026)
| Policy Change | Effective Year |
|---|---|
| $5 premium for auto-reenrolled $0 plans | 2026 |
| SEP pre-enrollment verification for 75% of new enrollments | 2026 |
| SEP for income ≤150% FPL repealed | 2026 |
| One-year tax filing rule to maintain APTC | 2026 |
| 60-day income verification extension removed | 2026 |
| Self-attestation no longer allowed if IRS data is missing | 2026 |
| Verification required if IRS reports income <100% FPL | 2026 |
| Exclusion of certain sex-trait procedures from EHB | 2026 |
| Wider flexibility in plan design (AV ranges) | 2026 |
| New method for adjusting ACA cost-sharing limits | 2026 |
| Standardized Open Enrollment Period (Nov 1–Dec 31) | 2027 |
🔍 Key Changes You Should Know
1. Tighter Rules for Subsidies and Tax Filing
If someone receives premium subsidies (APTC) but doesn’t file and reconcile their taxes, they’ll lose eligibility after just one year — instead of two. This is meant to cut down on people keeping coverage without following the rules.
Additionally, if the IRS doesn’t have income data for you, you’ll now have to provide documentation — self-attestation will no longer be enough.
2. $5 Premium Requirement for Automatic Re-Enrollments
Starting in 2026, CMS will impose a $5 monthly premium on individuals automatically re-enrolled in $0 premium plans unless they actively confirm their eligibility. Moreover, made this change to prompt consumers to stay engaged and ensure they still qualify for subsidies.
3. Stricter SEP (Special Enrollment Period) Rules
The monthly SEP for individuals under 150% of the Federal Poverty Level (FPL) is going away. In addition, at least 75% of new SEP enrollments must be verified with documentation before coverage can begin. CMS introduced these changes to prevent fraud and improper enrollments.
4. DACA Recipients Will No Longer Be Eligible
CMS is reverting to its earlier definition of “lawfully present,” which means DACA recipients will no longer qualify for ACA plans or subsidies starting in 2026.
5. More Flexibility in Plan Design
Insurance carriers will have more flexibility in how they design ACA plans, thanks to wider actuarial value (AV) ranges. This could result in more plan options and potentially lower premiums for consumers.
📍 What About Covered California?
While CMS has finalized these federal rules, Covered California has not yet announced how it will implement these changes at the state level. State-based exchanges like California’s have some flexibility in applying or adapting federal rules, so we’re still waiting for clarification.
It’s possible that California could take a different approach — for example, by keeping certain consumer protections in place or delaying implementation of specific provisions. We’ll update you as soon as more information becomes available. We expect the final guideline from Covered California, sometime in August or early September to be announced
✅ What You Can Do Now
If you’re currently enrolled in a Covered California ACA plan — or helping clients plan for the 2026 coverage year — now is the time to stay informed. These changes may affect eligibility, tax filing requirements, and how special enrollments work.
At Solid Health Insurance Services, we’re monitoring both federal and state updates to help you stay protected, avoid tax surprises, and choose the right coverage for your needs.
📞 Contact us anytime for personalized guidance.
