Regulatory Advisory reviews CMS finalized notice of benefit and payment parameters for 2026

The Centers for Medicare & Medicaid Services Jan. 13 released its standards for the health insurance marketplaces for 2026, including the issuers and brokers who assist marketplace enrollees. The final rule enhances CMS' authority to address and curtail misconduct by agents and brokers, such as fraudulent changes to an enrollee's health care coverage.  

CMS also finalizes updates to the risk adjustment program, medical loss ratio calculations and essential community provider certification review process, among other changes. Notably, CMS finalizes several policies to help enrollees better understand their costs and maintain coverage, such as updates to the premium payment threshold and a new enrollee notification process around tax filing and advanced premium tax credits. The final rule goes into effect Jan. 15.