HHS Finalizes Sweeping Marketplace Changes, Part 1: Higher Bronze Deductibles and Expansion of Catastrophic Plans, Health Affairs Forefront, May 18, 2026, by Katie Keith
On May 15, 2026, the U.S. Department of Health and Human Services (HHS) issued a highly anticipated 1,121-page (!) final Notice of Benefit and Payment Parameters rule for 2027 that makes sweeping changes to marketplace coverage under the Affordable Care Act (ACA). (The rule is available at https://www.cms.gov/files/document/cms-9883-f-patient-protection.pdf)
The final rule touches on topics such as expanded access to catastrophic plans with even higher out-of-pocket costs; new rules for the defrayal of state-mandated benefits; burdensome verification requirements; the elimination of standardized plans; and new policies to implement various provisions of the One Big Beautiful Bill Act (OBBBA).
This article discusses the final rule’s changes to the regulation and sale of catastrophic and bronze plans. A second article will discuss new policies to implement parts of the OBBBA (including immigration-related eligibility changes and elimination of the low-income special enrollment period); new cost-sharing reduction reporting requirements; and prior policies that were adopted in last year’s marketplace rule but set aside in court (including several verification requirements). Changes to essential health benefits requirements, standardized plans, network adequacy, essential community providers, risk adjustment, and other changes to the rules that govern the exchanges, insurers, and agents and brokers will also be addressed.
Trump Administration Embraces Catastrophic Plans with Even Higher Out-Of-Pocket Costs
Catastrophic plans are qualified health plans that do not cover benefits—other than preventive services and three primary care visits—until after the enrollee has reached the plan’s annual maximum out-of-pocket limit (MOOP), which is $10,600 for an individual and $21,200 for a family for 2026. [rising to $24,000 in 2027] ..
For 2027, some bronze MOOPs could be $15,600 for individual coverage and $31,200 for family coverage.
The final rule builds on these changes through three significant changes to catastrophic plans, two of which appear to be unprecedented. First, HHS codifies its recent guidance to allow many more people to categorically qualify for catastrophic coverage based on income alone. Second, beginning with the 2028 plan year, HHS will require catastrophic plans to have an even higher MOOP, meaning most care will not be covered until out-of-pocket expenses are even higher. Third, beginning with the 2027 plan year, HHS will allow catastrophic plans to exist for one year or for up to 10 consecutive years, and insurers that offer multi-year catastrophic plans will have more flexibility to design benefits.
HHS also strikingly suggests that insurers could help consumers with high deductibles by providing enrollees with a loan for their pre-deductible medical costs. Multi-year catastrophic plans could offer even more loan repayment flexibility. According to HHS, as long as a loan requires repayment, the plan would not technically be providing pre-deductible services in violation of the ACA’s requirements.
Comment:
By Don McCanne, M.D. and Jim Kahn, M.D., M.P.H.
Although many individuals and families had health insurance programs through government programs such as Medicare or Medicaid, and others had coverage through job-based private plans, many were still left uncovered. So in 2014 the Affordable Care Act provided the option of purchasing plans through insurance exchanges. Uninsurance dropped as a result, but higher premiums and cost-sharing (including deductibles) made health care finances challenging for many.
The Trump administration wants to greatly reduce government spending on the ACA. But, as the excerpt above explains, these changes shift so much cost to individuals and families that medical care will become unaffordable for many more of the ACA participants. This is detailed in the 1,121 page new rule (which we do not recommend tackling; read the Health Affairs piece instead). We know from news reports that coverage has already been worsened by the Trump administration: less coverage, more financial exposure, and thus inevitably more burdensome personal debt.
Let’s be clear: the upcoming changes to ACA exchange insurance policies challenge the fundamental purpose of insurance. They are a recipe for financial catastrophe for policy holders who have more than trivial health care needs. Cost-sharing of tens of thousands of dollars can be devastating.
All of this could be avoided and absolutely everyone could have comprehensive, affordable health care coverage by enacting and implementing a well-designed single payer Medicare for All program. Do you need a reminder of what that would look like? If so, just ask your favorite AI program to explain it to you. It will be easier and much more satisfying to read than the 1,121 pages of new rules on how to create less coverage and more financial hardship.
Single Payer! Let’s get serious about this.
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