The Centers for Medicare & Medicaid Services (CMS) released a proposed rule in early 2026 that would significantly modify plan design requirements for Affordable Care Act (ACA) Marketplace plans starting in plan year 2027. The changes target several provisions introduced in recent years to standardize benefits and protect consumers, which CMS now views as overly prescriptive.

Key proposed rollbacks include: Reducing standardization of cost-sharing tiers  Insurers would gain more leeway to vary deductibles, copays, and coinsurance across silver, gold, and platinum plans. Greater flexibility in actuarial value (AV) calculations Allowing plans to deviate further from the 60%, 70%, 80%, and 90% AV targets with wider de minimis ranges. Adjustments to essential health benefit (EHB) design  Easing limits on how plans structure coverage for certain services and medications. Modifications to out-of-pocket maximum rules Potentially permitting higher OOP limits in specific scenarios to offset premium reductions.

CMS justifies the proposals by stating that excessive standardization has limited innovation, reduced plan diversity, and contributed to premium increases in some markets. The agency believes greater flexibility will encourage insurers to offer more affordable options, particularly in rural and underserved areas, while still maintaining core ACA protections.

Stakeholders are divided. Insurer groups and some state regulators support the move, arguing it will improve market stability and choice. Consumer advocates and patient organizations express concern that loosened rules could lead to weaker coverage for people with high-cost conditions, higher out-of-pocket burdens, and “skimpy” plans that deter enrollment among sicker individuals.

The proposal is open for public comment through the standard rulemaking period. Final rules are expected later in 2026, with any approved changes taking effect for the 2027 open enrollment season.