Episode Summary
In this episode, we break down the CMS Final Rule for the 2025 Marketplace and what it means for agents, insurers, and consumers.
Key highlights include:
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Past-due premium enforcement: Carriers may require payment of prior premiums before activating new coverage, with flexibility for state-specific rules.
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Standardized Open Enrollment:
→ 2026: Nov 1 – Jan 15
→ 2027 and beyond: Federal deadline of Dec 15 -
Tighter eligibility verification: 75% of applications will be randomly selected for verification.
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DACA exclusion: DACA recipients will no longer be eligible for Marketplace coverage.
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Financial impact: CMS estimates $12 billion in savings and an average 5% premium reduction due to increased oversight and fraud prevention.
This final rule is a major step toward greater compliance, reduced fraud, and a more stable Marketplace.
