NBPP Proposed Rule Brings Additional Changes for Consumers
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The Marketplace continues to change
In the last year, the Health Insurance Marketplace® — where over 15 million people get their health insurance — has seen drastic policy changes. New requirements from The Integrity and Affordability Final Rule and H.R. 1 will impact how consumers demonstrate eligibility for and enroll in coverage over the next few years, such as shorter Open Enrollment Periods and removal of automatic reenrollment, as well as ending eligibility for coverage assistance for certain noncitizen groups.
Additionally, the recent expiration of the enhanced premium tax credits significantly increased the cost of coverage beginning this most recent Open Enrollment Period. So far, over one million fewer people enrolled in coverage this past Open Enrollment Period compared to last year. Navigators and certified assisters have played a critical role in helping consumers traverse these changes, and their services will continue to be essential as even more changes for consumers may be coming.
The Notice of Benefits and Payment Parameters (NBPP) for 2027 Proposed Rule, released at the end of the January 2026, addresses operations and risk adjustments for the Marketplaces in the upcoming plan year. This year’s proposed rule includes changes on agent oversight and issuer accountability, plan structure, and State-Based Marketplace requirements, as well as alignment with new requirements in H.R. 1.
Summary of NBPP Impact
These proposed provisions would affect how consumers select plans, access care, and enroll, with accompanying impacts on states, issuers, agents, brokers, assisters, and providers. See a summary in the following table, and keep reading for more detail on each provision change.
| NBPP Proposed Rule Provision Change | Impact on Consumers |
|---|---|
Standardized plan options would no longer be required and there would be no limit on non-standardized plan options. | Consumers would see big changes to plan offerings. |
Non-network plans could receive qualified health plan (QHP) certification. | |
Catastrophic plan eligibility would be expanded, and multi-year plan terms and higher out-of-pocket maximums would be permitted. | |
Pre-enrollment Special Enrollment Period (SEP) verification would allow Federally-facilitated Marketplaces (FFMs) to verify SEPs beyond loss of minimum essential coverage, and require FFMs to verify at least 75% of new enrollments through SEPs (reintroduced). | Consumers would face continued enrollment barriers. |
When data sources show consumers’ income is under 100% of the Federal Poverty Level (FPL), income verification would be required (reintroduced). | |
Income attestation would no longer be accepted when no IRS data is returned (reintroduced). | |
Adult dental services would be prohibited as an Essential Health Benefit (EHB). | Consumers would have less access to certain care. |
The minimum percentage of Essential Community Providers to contract with each plan service area would be reduced from 35% to 20%. | |
Any additional state-mandated benefits to EHB would be separated from federal EHB and states must cover the cost. |
NBPP Impact #1: Consumers would see big changes to plan offerings
Shopping for health coverage can already be a stressful process, and the proposed rule would allow issuers to offer more plans and plan types, potentially adding more confusion as consumers attempt to compare and select the best option.
Specifically, the NBPP proposes:
- Removing a requirement for issuers to offer standardized plan options, which show plans with the same cost sharing requirements by plan metal level to make comparing plans more straightforward, as well as removing the limit of non-standardized plan options, which would permit issuers to put more plans on the market.
- Allowing non-network plans to be newly offered on the Marketplace, where plans set benefit amounts for covered services, and consumers would pay the difference between the cost of care and set amount, when applicable.
- Making catastrophic plans, a type of high-deductible/lower-premium plan primarily designed for those under 30 years old, permanently available to people of all ages who earn less than 100% of the Federal Poverty Level (FPL) or more than 250% FPL. Consumers with these plans could see out-of-pocket maximums and deductibles exceed $15,000.
Bottom Line: With these new plan options potentially shifting the market in unprecedented ways, consumers will require additional support and education from certified assisters to understand the options and select the best plan for their household.
NBPP Impact #2: Consumers would face continued enrollment barriers
In summer 2025, the Integrity and Affordability Final Rule brought about significant changes to Marketplace eligibility and enrollment. However, some of those changes did not go into effect after two cases where the court stayed those provisions. Now, the NBPP proposed rule is reintroducing those stayed provisions, including:
- Requirements for more verification for applications seeking coverage during a Special Enrollment Period, where a special circumstance qualifies someone to enroll in coverage through the Marketplace, such as loss of other minimum essential coverage, a change in household like getting married or having a baby, or a change in residence.
- Requirements that applicants provide additional documentation on income when data sources don’t match stated income or no data is found on income, which can be especially challenging for those who have multiple sources of income or variable earnings.
Bottom Line: If finalized, CMS estimates these changes would create additional enrollment hurdles for over three millions Marketplace consumers a year and add an hour or more to the application process for consumers to provide the necessary paperwork. Additional hurdles at the point when an individual or household is seeking coverage could delay enrollment and access to care.
NBPP Impact #3: Consumers would have less access to certain care
When someone enrolls in coverage, it is important for them to be able to access care using that coverage. All plans on the Marketplace cover 10 Essential Health Benefits (EHBs), such as emergency services, preventative care, and prescription drugs. They also must provide a sufficient network of providers, ensuring consumers can receive the services they need with their plans.
The NBPP proposes changes that would impact how some consumers access certain care:
- States that mandate any additional benefits beyond the 10 required EHBs would need to cover the cost. In response, states may choose to limit or eliminate additional EHBs if they are unable to cover the cost, therefore reducing access to services like hearing aids, nutritional screenings, or increased access to medications for opioid use disorder.
- States would no longer be able to include adult dental services as an EHB.
- The requirement of how many Essential Community Providers (ECPs) plans need to contract with would reduce from 35% to 20%. These safety-net providers, such as community health centers and Federally Qualified Health Centers (FQHCs), serve primarily low-income and medically underserved communities.
Bottom Line: Consumers would need to be aware of changes to their included benefits or changes to provider access if going to an ECP.
What’s next
The comment period for the proposed rule runs until March 13, 2026, and then CMS will finalize the rule, likely by summer 2026. Transform Health continues to analyze these changes and impacts on the health coverage landscape.
In the meantime, trusted guidance from Navigators and assisters will continue to be vital in supporting individuals and their families to find and understand coverage options in a changing landscape.
Do you want a more personalized analysis of how the NBPP and related policies may affect your work and your community? Transform Health is here to help. Book a free discovery call today.
Transform Health is an Inc. 5000-ranked national private health care consulting firm with a mission to drive systems change to build healthy communities.