Federal health officials want to change what happens to people on the Affordable Care Act marketplace who do not confirm their eligibility every year. Under a proposed rule, enrollees who skip the check would be automatically re-enrolled without any premium subsidy, beginning with 2028 plans. The Centers for Medicare and Medicaid Services announced the proposal on October 23, and it is not in effect.
What the proposed rule would require
The core change is in annual renewal. Currently enrolled consumers would be re-enrolled with financial assistance only if they return to the marketplace each year to confirm eligibility criteria and have them re-verified. Otherwise, they would be automatically re-enrolled without it.
Financial assistance here means two things: advance payments of the premium tax credit, which lower the monthly premium, and income-based cost-sharing reductions, which lower deductibles and copays. According to CMS’s fact sheet on the rule, the marketplace would verify four things before paying out: household income and family size, citizenship or eligible immigration status, other coverage, and place of residence.
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CMS says the rule would not affect consumers who do not apply for or are not eligible for financial help. That leaves out anyone paying full price. It covers new applicants and people who now receive tax credits or cost-sharing help, whether they use HealthCare.gov or a state-run exchange.
A proposal still working its way to the Federal Register
The proposed rule is listed on the Federal Register’s public inspection page as document 2026-21891, a 203-page filing from the Department of Health and Human Services. It was filed October 23 and is scheduled to be published October 27.
Public comment runs for 30 days after publication. The release does not give a deadline date and the filing is still unpublished. CMS also asks for comment on how to strengthen family size and residency checks, including which data sources to use.
The rule reaches beyond the federal HealthCare.gov platform. The fact sheet lists federally run exchanges, state-based exchanges and state exchanges that use the federal platform, plus insurers, which would follow existing rules on first-month payments for new enrollment. States that want to start their own exchange would have to file their application 15 months before the verification period begins.
Nothing is final until CMS reviews the comments and issues a final rule. The agency has not said when that might happen. Plan years before 2028 are not touched by the proposal as written.
The August 1 window and the gap while documents are pending
CMS would require every marketplace to offer a verification period starting August 1 each year, ahead of open enrollment. It is voluntary for consumers. The first one would start August 1, 2027, for 2028 coverage, giving applicants time to submit documents before they pick a plan.
Under the proposal, a person whose information cannot be confirmed electronically enters what CMS calls an inconsistency period and must send documents. The marketplace would no longer be allowed to pay financial assistance during that period for criteria it could not verify electronically.
The fact sheet softens the effect in two ways. Consumers could enroll without help while verification is pending, and assistance would be paid retroactively for those months once eligibility is confirmed. A consumer could also choose a plan that takes effect only if later found eligible for help, even after open enrollment ends.
There are exceptions. Verification would be waived for certain special-enrollment changes in family size, such as a birth, adoption or marriage, or the loss of a dependent through divorce, separation or death.
Why the administration says it is needed
CMS Administrator Dr. Mehmet Oz said, “Federal subsidies should only go to eligible Americans, not to fraudsters gaming the system.” Treasury Secretary Scott Bessent said hardworking taxpayers should not be forced to subsidize health care for people ineligible under federal law.
The release says the rule implements provisions of the Working Families Tax Cuts law, Public Law 119-21. Treasury issued its own regulations on October 15, 2026, according to the fact sheet. CMS includes no dollar estimate of the fraud it expects to stop and no enrollment figures for the people the rule might affect.
What a missed check could cost an enrollee
The practical risk is a lost renewal, and the burden shifts to the enrollee. A person who does not respond in time would carry a plan with no premium tax credit, and cost-sharing help would stop too. The enrollee would have to act every year to keep the subsidy.
Whether the final rule keeps the August 1 window, the 30-day comment period and the 2028 start remains open until CMS responds to comments. For now, nothing changes for 2027 coverage. Anyone who relies on a premium tax credit can read the Federal Register filing once it publishes and file a comment before the 30 days end.
Ready for a yearly check that could cost a marketplace subsidy?
If CMS’s proposal is finalized as written, one missed yearly confirmation could mean paying full price for a marketplace plan the next January. Households between 50 and 64, with no Medicare yet, feel that first, and there is no marketplace kit to help with it.
The Benefits Checklist covers the other income-tested help a household can apply for in the meantime. It scans 11 benefit programs, lists the 2026 income limits and includes a printable application tracker for keeping dates straight.
Get the 11-program scan and printable tracker →
More Financial Reading
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- 15 Ways Retirees Are Tapping a Record $14.9 Trillion in Home Equity
This article was produced with AI assistance and edited for accuracy against the sources linked above.
