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On April 2, 2024, the Biden-Harris Administration, through the Centers for Medicare & Medicaid Services (CMS), announced measures that will make coverage more accessible, simplify choice, and make it easier for millions of Americans to select a health plan in 2025.
“More than 21 million Americans signed up for high-quality, affordable health care coverage through the ACA Marketplaces in 2024. We want to build on this success to make Marketplace plans even better,” said U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra. “This rule will allow coverage of routine dental benefits for the first time, expand requirements to ensure reliable access to health care providers, and ensure consumers with lower incomes can sign up for coverage when they need it.”
The 2025 Notice of Benefit and Payment Parameters Final Rule (2025 Payment Notice) finalizes standards for issuers and Marketplaces, as well as requirements for agents, brokers, web-brokers, and assisters that help consumers with enrollment through Marketplaces that use the federal platform. These changes further the Biden-Harris Administration’s goals of advancing health equity by addressing the health disparities that underlie our health system, such as strengthening network adequacy standards and extending Special Enrollment Periods (SEPs) for qualifying consumer groups. The rule also builds on the Affordable Care Act by expanding access to quality, affordable health coverage and care, especially dental health plans and access to prescription medication, and making it easier to select and enroll in health coverage.
Major provisions related to agents and brokers include:
- New rules about Marketplace network adequacy, including time and distance standards for qualified health plans (QHPs) and network adequacy reviews to evaluate compliance with these standards.
- Standardizing the dates of Open Enrollment periods across almost all Marketplaces to generally begin on November 1 and end no earlier than January 15, with the option to extend the Open Enrollment period beyond January 15.
- Extending the SEP for consumers with household incomes at or below 150% of the FPL (for the 2025 plan year, $38,730 for a family of three) to be able to enroll in coverage in any month rather than only during Open Enrollment.
- Additions to health products and services that qualify as essential health benefits (EHBs), such as routine adult dental services and prescription drugs that are covered by a QHP but exceed those covered by a state’s EHB-benchmark plan.
For more information, view the full press release below.
Additional resources:
CMS also released the 2025 Final Actuarial Value (AV) Calculator and Methodology.
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