HHS Notice of Benefit and Payment Parameters for 2027 Proposed Rule

As it does each year, the Department of Health and Human Services (HHS) released its annual Exchange regulations – the proposed Notice of Benefit and Payment Parameters for 2027 – this month. The accompanying Draft Letter to Issuers on the Federally-facilitated Exchanges was published on February 25, 2026.  The Health Policy News team will provide an overview of the Letter and additional updates in our upcoming March edition. The summary below outlines key changes to Qualified Health Plan (QHP) certification and Exchange standards. For more information on these topics and others – including changes to the risk adjustment program, broker standards, eligibility standards, insurance reporting requirements, medical loss ratio, and user fees – we encourage you to consult the full proposed rule.

Comments on the proposed rule are due on March 13, 2026 and PCG’s subject-matter experts will monitor further rule-making and guidance.

1. Standardized Plans

The NBPP proposes the “discontinuation of standardized plans” on the Federally-facilitated Exchanges (FFEs) and State-based Exchanges on the Federal Platform (SBE-FPs), despite the successful legal challenge to a similar proposal in 2019. If finalized, FFE and SBE-FP issuers would no longer be required to offer standardized plans and the FFEs would no longer have differential display for such plans. Additionally, the federal government would no longer design and publish yearly standardized plan templates and issuers would no longer be limited in the number of non-standardized plans they can offer.

The proposal does not require issuers to discontinue existing standardized plans and states can continue to require standardized plans, though only those on State-based Exchanges could have differential display.

2. Network Adequacy and Essential Community Providers (ECP)

The NBPP proposes to remove the requirement that states that conduct network adequacy reviews use quantitative time and distance standards that are at least as stringent as federal standards. Instead, similar to a policy that was also previously overturned by the ruling in City of Columbus v. Cochran, states would be able to review for network adequacy as long as they meet the following standards:

• • In SBE and SBE-FP states: The state ensures plans provide sufficient access to providers.

  • In FFE states: The state meets new process standards for an Effective Provider Access Review Program, based on meeting specific criteria demonstrating that the state has sufficient authority and the technical capacity to conduct such reviews.

Plans in those states would no longer need to comply with federal standards.

The NBPP also proposes an Effective Essential Community Provider certification Review Program for FFE states, allowing states to conduct the review if they meet requirements similar to those for network adequacy. In addition are the following changes to ECP standards:

• • Reduction of the ECPs threshold (the minimum percentage of available ECPs that must be included within the provider network) from 35% to 20%

  • Allowing for a less robust justification narrative if a plan does not satisfy the ECP standard

HHS also proposes to allow non-network plans to be newly certified as QHPs as long as they are determined to provide sufficient access to providers – based on having a benefit amount for a covered service that is sufficient enough that an adequate number of providers will accept it as payment in full – and meet other QHP standards.

3. Essential Health Benefits (EHB)

HHS is also proposing to require states to defray the cost of all state-mandated benefits enacted after 2011, even services that are embedded in the state’s EHB-benchmark plan. While this is proposed to go into effect in 2027, HHS is considering delaying implementation to 2028 to accommodate legislative and operational needs.

The rule also proposes prohibiting states from including routine non-pediatric dental services as an EHB, even if the State’s current EHB-benchmark plan includes such services as covered benefits.

4. Cost-sharing Limits

HHS proposes significant updates to cost-sharing rules for bronze and catastrophic plans, allowing insurers to offer such plans with cost sharing that exceed statutory maximum out-of-pocket (MOOP) limits.

For bronze plans in the individual market, HHS would permit issuers that offer at least one plan that complies with cost-sharing limitations to offer an alternative cost-sharing design plan in the same service area with a MOOP that exceeds statutory limits. Catastrophic plans would provide no benefits (except preventive services, including three primary care visits) for any plan year until enrollees reach reach a MOOP of 130% of the maximum annual limitation, rounded down to the nearest $50 ($15,600 for an individual and $27,600 for a family for 2027).

5. Catastrophic Plans

The NBPP proposes other significant changes to catastrophic plans. First, HHS proposes to codify guidance released based on H.R. 1 to allow anyone who is ineligible for advance premium tax credits based on income to enroll in catastrophic plans regardless of age.

The NBPP would also allow issuers to offer multi-year catastrophic plans and enroll individuals for periods of up to 10 years. Individuals could remain enrolled as long as they were eligible at the initial time of enrollment, and the annual limitation on cost sharing could be averaged across years.

6. Advance Premium Tax Credit (APTC) Eligibility and Basic Health Plan

The proposal seeks to implement the H.R.1 requirement by redefining the term “eligible noncitizens” (who are eligible for APTCs) as an individual who is either lawfully admitted for permanent residence, an individual who has been granted the status as Cuban-Haitian Entrant, or an individual who is lawfully residing in the U.S. as a COFA migrant. Other individuals who are ineligible for Medicaid due to their immigration status would no longer be eligible for APTCs.

States that enroll other non-citizens in the Basic Health Plan (BHP) would not be eligible for federal BHP payments for those individuals.

7. Establishment of State-based Exchanges (SBE) and Direct Enrollment

HHS proposes to rescind the requirement that states must operate a State-Based Exchange on the Federal Platform (SBE-FP) for one year before establishing a SBE.

The NBPP also proposes a new SBE-Enhanced Direct Enrollment (SBE-EDE) model. This would eliminate the requirement that SBEs operate a centralized consumer-facing eligibility and enrollment platform, and would allow SBEs to rely on private-sector direct enrollment platforms to allow consumers to select and enroll into a QHP. The SBE would still be required to process eligibility and enrollment.

States seeking to implement this model would need to submit a Blueprint application or revision to HHS at least 15 months prior to their targeted open enrollment date, and would need to demonstrate that at least one selected EDE can enroll all consumers statewide.