CMS finalizes marketplace network rules: 5 things to know

CMS finalized several proposed changes to regulations for the ACA marketplace in 2025. 

Beginning in 2026, the agency will require state-based marketplaces to adopt network adequacy standards that are at least as stringent as those required by the federal marketplace, according to an April 2 news release from CMS. These standards include the maximum time and distance beneficiaries can travel to the nearest in-network provider. 

CMS published its proposed rule in November. 

Here are five more changes to note: 

  1. CMS will allow states to include non-pediatric routine dental services as an essential health benefit. 

  2. The rules will standardize open enrollment periods across state and federal marketplaces. State-based marketplaces will be required to begin open enrollment on Nov. 1 and end open enrollment no earlier than Jan. 15. 

  3. CMS will extend special enrollment periods for those with incomes up to 150% of the federal poverty line. Low-income enrollees will be able to select marketplace coverage at any point during the year. 

  4. The new rule will add an exception to the limit of non-standard plans insurers can offer, designed to incentivize plans targeted toward specific chronic conditions. 

  5. Members enrolled in catastrophic plans will automatically be re-enrolled for the next year unless they opt for new coverage. The rule is designed to minimize coverage gaps, CMS said. 

Read more here. 

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