The Trump administration on Friday finalized a major rule reshaping the Affordable Care Act exchanges, including increasing access to nontraditional and cheaper policies that come with much higher deductibles.
CMS officials said the changes, which go into effect in 2027, would increase consumer choice, crack down on improper enrollments and lower premiums — a particular concern for millions of Americans contending with elevated costs for coverage this year.
More generous subsidies for ACA plans expired at the end of 2025, sparking a cost crisis that’s resulted in 1.2 million fewer people signing up for coverage in the exchanges set up by the 2010 law. Hundreds of thousands more Americans have turned to plans with cheaper monthly costs but significantly higher cost sharing — a risky decision that could saddle them with out-of-pocket spending if they get seriously ill.
Friday’s final rule paves the way for more people to make the same choice, expanding access to catastrophic plans, which were originally crafted as bare-bones coverage for healthy young adults or as coverage of last resort for people experiencing hardships like homelessness.
Catastrophic plans cover essential benefits at a lower monthly cost but come with high cost-sharing, including an annual deductible of more than $10,000 for an individual in 2026.
The final rule allows people to enroll in catastrophic plans with a term of up to 10 years, and allows individuals who don’t qualify for ACA subsidies to enroll in catastrophic plans when their household income changes.
CMS officials say that catastrophic coverage is a valid alternative for people priced out of other types of plans. The Trump administration first expanded access to the plans last fall, in advance of looming premium spike for ACA coverage.
But catastrophic plans are not a replacement for comprehensive coverage, experts say. The plan design leaves people vulnerable to very high costs and can lead to them avoiding medical care they need or ending up in debt.
The expansion — and other provisions in the rule’s draft version published in February — sparked concerns from insurance experts and a broad swath of the healthcare industry, with providers and patient advocates arguing that the rule would weaken patient protections, increase hospitalizations and raise the uninsured rate.
The final rule takes other steps to expand access to nontraditional plans, aligning with President Donald Trump’s longstanding advocacy of alternatives to conventional ACA coverage.
Regulators repealed a requirement that insurers offer standardized ACA plan designs, which help consumers more easily compare coverage by creating common cost-sharing across the bronze, silver, gold and platinum plan categories. They also nixed the limit on the number of non-standard plans that insurers can offer.
The final rule also allows companies to sell plans without provider networks on the exchanges for the first time.
Instead of contracting or negotiating payment rates with a designated set of providers, the plans set amounts that members can be reimbursed for specific services.
CMS officials said the policy would allow people to shop between providers for lower prices. However, the so-called “non-network plans” typically come with high deductibles. And it’s tricky to tell whether the coverage satisifies the ACA’s requirement that plans create sufficient access to providers, traditional insurers say.
The final rule also requires the state and federal exchanges to do more to ensure enrollees are eligible to sign up for an ACA plan or receive a subsidy for their coverage — including two policies that the Trump administration tried to enact last year before they were temporarily blocked by a judge.
Now, starting in 2027, exchanges will have to verify the eligibility of more enrollees who sign up during special enrollment periods, and perform additional verification for very low-income enrollees and people without tax data backing up their eligibility for subsidies.
The final rule also enacts certain provisions of the GOP’s “Big Beautiful Bill” passed last summer, including nixing a special enrollment period for low-income individuals and preventing undocumented immigrants and other low-income immigrants, even if lawfully present in the country, from receiving subsidies.
Regulators also slashed the fees that insurance companies pay to participate in the exchanges, and tightened marketing standards for brokers who help individuals sign up for coverage.
