CMS Issues Proposed Rule on HHS Notice of Benefit and Payment Parameters for 2026; Comments Due November 12

The Centers for Medicare & Medicaid Services (CMS) released a notice titled, "Premium Adjustment Percentage, Maximum Annual Limitation on Cost Sharing, Reduced Maximum Annual Limitation on Cost Sharing, and Required Contribution Percentage for the 2026 Benefit Year."

The 2026 maximum annual limitation on cost sharing is:

• $10,150 for self-only coverage and
• $20,300 for other than self-only coverage.

This represents an approximately 10.2% increase from the 2025 parameters of $9,200 for self-only coverage and $18,400 for other than self-only coverage.

(Updated October 10, 2024)

The Centers for Medicare & Medicaid Services (CMS) released the annual proposed Notice of Benefit and Payment Parameters for the 2026 benefit year. The notice applies to health plan issuers offering qualified health plans through the Affordable Care Act (ACA) state and federal marketplaces, and includes requirements for agents, brokers, and assisters that help consumers enroll in marketplace coverage. The notice affects individual market qualified health plans, stand-alone dental plans, and all Small Business Health Option Program (SHOP) plans.

Beginning in 2025, the rule proposes additional safeguards to protect consumers from fraudulent changes to their health care coverage, as well as options to ensure the integrity of the Federally Facilitated Marketplace (FFM).

Comments are due November 12, 2024.

Additional Information
Fact sheet

(Posted October 7, 2024)