CMS is proposing a set of new regulations for ACA marketplaces, including shortening the annual enrollment window and rescinding eligibility for DACA recipients.
In a March 10 news release, the agency said the changes are designed to address "the troubling amount of improper enrollments" in the marketplace.
In the first quarter of 2024, CMS said it received 40,000 complaints of customers being enrolled in ACA plans, or switched into a new plan, without their knowledge.
Here are five things to know about the proposed rules:
- The agency pitched shortening the annual enrollment period by one month. Under the proposed rule, open enrollment would run from Nov. 1 to Dec. 15. Currently, the open enrollment period begins Nov. 1 and ends Jan. 15. The change would align more closely with enrollment dates for employer-sponsored coverage and "reduce the risk of adverse selection from consumers who otherwise may wait to enroll until they need healthcare services," according to the agency.
- The proposed rules would also eliminate a special enrollment period that allows individuals with incomes under 150% of the federal poverty limit to enroll in coverage in any month. The policy "allows people to wait to enroll until they become sick," the agency said.
- The regulation would reverse a proposal by the Biden administration that would have allowed Deferred Action for Childhood Arrival recipients to enroll in ACA plans. The DACA program allows individuals brought to the U.S. as children without legal status to remain in the country. In December 2024, a federal judge blocked DACA recipients from enrolling in ACA plans.
- Under the new regulations, consumers would be required to re-verify their eligibility for fully subsidized plans each year. If enrollees do not verify their eligibility, they will pay a $5 monthly premium until they confirm or update their eligibility. The change would cut back on fraud by ensuring individuals are aware of the coverage they are enrolled in, CMS said.
- The rule would bar insurers from covering "sex trait modification services," or gender-affirming care, as essential health benefits. The proposal would not prohibit health plans from voluntarily covering these services, the agency said.
Enrollment in the ACA marketplace reached a record high of 23.6 million in 2025, spurred by increased federal subsidies, reducing the cost of premiums for most beneficiaries. The enhanced subsidies are set to expire at the end of 2025.
In February, the Trump administration slashed funding for the ACA Navigator program, which helps beneficiaries enroll in ACA plans. According to CMS, navigators enrolled fewer than 1% of ACA beneficiaries during the open enrollment period, despite receiving $98 million in funding.
The proposed rule is open for comment 30 days from its official publication in the Federal Register.