The 2027 ACA marketplace rule: lower issuer user fees, decade-long catastrophic plans
CMS finalised the Notice of Benefit and Payment Parameters for 2027. It sets federal Exchange user fees at 1.9% and 1.5% of premiums and lets catastrophic plans run up to ten years.
Every year the Centers for Medicare & Medicaid Services issues a rule that sets the operating parameters for the Affordable Care Act's health insurance marketplaces for the coming benefit year. For 2027, that rule — the HHS Notice of Benefit and Payment Parameters — was published in the Federal Register on 20 May 2026 and took effect on 20 July 2026 [s1]. It is dense and technical, and it is one of the documents that determines what marketplace coverage costs and how it is structured.
This article reports what the final rule sets. It does not characterise the policy as good or bad, and it makes no prediction.
What issuers will pay to use the Exchanges
Insurers that sell qualified health plans through the federal platform pay a user fee, charged as a percentage of the premiums they collect, to fund the operation of the marketplace. For the 2027 benefit year, CMS is "finalizing 2027 benefit year FFE and SBE-FP user fee rates of 1.9 percent and 1.5 percent of total monthly premiums, respectively" [s1]. "FFE" is the Federally-facilitated Exchange; "SBE-FP" is a state-based Exchange that uses the federal platform.
User fees matter to consumers because they are built into premiums. A fee charged on premium dollars is, ultimately, part of what the premium has to cover.
A smaller charge inside the risk-adjustment programme
The rule also sets the fee that funds the HHS risk-adjustment programme, which moves money between insurers to offset the cost of enrolling sicker members. CMS writes that it is "finalizing an HHS risk adjustment user fee rate for the 2027 benefit year of $0.18 PMPM, which is lower than the rate for the 2026 benefit year" [s1]. PMPM means per member, per month. The agency notes the 2026 rate was $0.20 PMPM, and says it "anticipate[s] that the overall impact on pricing of an $0.18 PMPM HHS risk adjustment user fee rate will be minimal, since it is lower than the user fee rate for the 2026 benefit year" [s1].
The risk-adjustment design also carries a high-cost risk pool. The rule describes truncating costs "by removing 60 percent of costs above the $1 million threshold" when calculating certain transfer parameters [s1] — a mechanism that spreads the expense of very high-cost patients across insurers.
Changes to plan structure
Two structural changes stand out in the rule's own summary. First, it provides for the "establishment of catastrophic plans with plan terms of up to 10 consecutive plan years" [s1]. Catastrophic plans are low-premium, high-deductible plans with limited eligibility; allowing a plan term to run up to a decade is a change in how long such a plan can stay in market.
Second, the rule finalises "the expansion and codification of hardship exemption eligibility" [s1], which governs who can be excused from certain coverage requirements, and implements a "State Exchange Improper Payment Measurement (SEIPM)" programme to measure improper payments in state-based Exchanges [s1]. The rule also sets civil money penalties for noncompliant issuers and revises standards governing agents, brokers and web-brokers [s1].
Why these parameters are worth reading plainly
None of these figures is a headline on its own. Taken together they set the machinery: what insurers are charged to participate, how money moves between them, what kinds of plans can exist and for how long, and how the government measures payment accuracy. Those are the levers that sit beneath the premium a household eventually sees.
How it connects to the rest of the rulemaking
The payment rule is not the only 2027 marketplace document in motion. CMS later issued a separate proposed rule, published 27 October 2026 and open for comment until 27 November 2026, that would change how Exchanges verify eligibility before enrolment [s2]. The payment parameters and the verification proposal address different parts of the same programme.
What this article is not
This is a description of a finalised federal rule. It is not advice about choosing a plan, and the effect of any parameter on an individual household depends on income, plan choice, state and the premiums insurers actually file.
What to watch
Whether insurers' 2027 premium filings reflect the lower risk-adjustment fee the rule sets [s1]. How many catastrophic plans take up the longer plan terms the rule now permits. And whether the separate eligibility-verification proposal is finalised alongside these parameters [s2].
Sources
- Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027 (Final Rule) — Centers for Medicare & Medicaid Services / Federal Register , May 20, 2026
- Patient Protection and Affordable Care Act, Exchange Pre-Eligibility Verification (Proposed Rule, CMS-9873-P) — Centers for Medicare & Medicaid Services / Federal Register , October 27, 2026
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