The following information is a copy of a memo distributed by Health Sherpa:
We want to give you an early heads-up about some significant proposed changes to the ACA Marketplace rules likely to take effect in the years ahead. While these changes aren’t final yet, the industry consensus is that they will move forward in one form or another.
What’s changing?
- End of the <150% FPL Special Enrollment Period (SEP)
The monthly SEP for individuals under 150% FPL would be discontinued. - $5 Monthly Premium for Fully Subsidized Passive Renewals
Consumers eligible for $0 premium plans who don’t actively confirm their income may be required to pay $5/month until they verify. - Shorter Open Enrollment Period
Open Enrollment is slated to end on December 15, 2025. - Other proposed changes are currently under review, which we’re monitoring closely.
Why it matters
These rules will bring about a lot of change that could impact members, businesses, and the reach of the ACA. These proposed rules heavily favor active renewals over passive enrollment and focus on program integrity to further reduce fraud. HealthSherpa has always been an “active enrollment” platform, and we’ll be here to guide you and your clients through these changes, with the goal that no one loses coverage unexpectedly.
We’re here to support you
- Product Updates
Our platform will adapt to any new verification or enrollment processes as soon as CMS finalizes them, so you can continue servicing clients smoothly. - Expert Guidance
Look out for training webinars, email updates, and resource guides that will help you navigate each change step by step. - Advocacy
We’re working directly with CMS and key stakeholders to stay on top of policy developments. You can rely on us for clear, timely information.
We know these changes are significant, but rest assured that our goal remains the same: to help you enroll clients in the coverage they need.
