From Beyond the Basics
"Late last week, Congress passed and the President signed the One Big Beautiful Bill Act, which makes sweeping changes to ACA marketplace eligibility and enrollment as well as Medicaid. As noted below, provisions in the bill intersect with several provisions in the Marketplace Program Integrity Final Rule (some of which sunset at the end of Plan Year 2026), and makes additional changes. See a brief summary of marketplace changes below.
Summary of Marketplace Provisions in Newly Enacted Law
Effective January 1, 2026:
- Eliminates the provision allowing lawfully present immigrants who are ineligible for Medicaid due to their status and whose income is less than 100% of the FPL to access Premium Tax Credits (PTCs).
- No PTCs allowed for people who enroll via an income-based SEP.
- Interaction with marketplace rule: The rule eliminates the year-round SEP for people with incomes at or below 150% of the federal poverty in all states beginning August 25, 2025 and sunsetting December 31, 2026.
- Ends the repayment limits that protect enrollees with low and moderate incomes from owing large amounts of their Advance Premium Tax Credits (APTCs) back at tax time if their estimated income or household size changes during the year. Note this provision takes effect for APTCs received in 2026, but will not be felt by enrollees until they reconcile APTCs in early 2027.
Effective January 1, 2027:
- Eliminates PTC eligibility for most lawfully present immigrants, including refugees, people granted asylum, certain survivors of domestic violence, sex or labor trafficking, and other crimes, special immigrant juveniles, and others. Only U.S. citizens, legal permanent residents, certain Cuban and Haitian entrants, and people from COFA nations will be eligible.
- Interaction with marketplace rule: The rule makes DACA recipients ineligible for marketplace coverage beginning August 25, 2025.
Effective January 1, 2028:
- Eliminates provisional APTC eligibility, preventing people from getting APTCs until the marketplace has verified their income and other eligibility criteria. Allows the Secretary to waive this requirement for people enrolling during an SEP due to a change in family size. A person in this circumstance (e.g. a newborn) would be eligible to receive PTCs while the household is in the process of verifying their eligibility.
- Interaction with marketplace rule: The rule implements additional paperwork and verification requirements beginning August 25, 2025. Some of these provisions sunset on December 31, 2026.
- Requires all enrollees to take action to continue their coverage from one year to the next, eliminating automatic re-enrollment. Allows marketplaces to use third party sources to generate information to be verified by the applicant.
- Interaction with marketplace rule: The rule begins charging a $5 fee for people who automatically reenroll in their marketplace plan (rather than actively reenrolling) in states that use HealthCare.gov, effective for reenrollment for 2026 coverage."
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