Federal · CMS proposed rule, CMS-9873-P

HealthCare.gov proposed rule: confirm your income and other details each year to keep premium help, starting with 2028 coverage

Proposed Oct. 23, 2026 · Comments due 30 days after Oct. 27 publication

Published October 25, 2026 · Last updated October 25, 2026

What it does

This is a proposed rule. It would amend the Marketplace (Exchange) eligibility and enrollment rules in 45 CFR part 155 to carry out section 71303 of Public Law 119-21 (July 4, 2025), which CMS calls the Working Families Tax Cut (WFTC) legislation. That law says that, for tax years beginning after December 31, 2027, a month generally counts toward the premium tax credit only if the Marketplace verifies the enrollee’s eligibility using information the applicant provides or verifies, including household income and family size, immigration status, other health coverage and place of residence. (Proposed rule, Summary and sections I.A and II)

The law also requires each Marketplace to have a process, no later than August 1, 2027, that lets anyone verify their household income and eligibility for the next plan year. (Proposed rule, section II) CMS proposes:

• A pre-enrollment verification period. Every Marketplace would let people provide eligibility information for the next plan year starting August 1 each year, until open enrollment begins. The first would start August 1, 2027, for 2028 coverage. (Proposed rule, sections I.B and III.A.1; proposed § 155.410(h))
• Confirm your information to keep premium help at renewal. Marketplaces would still redetermine eligibility every year, but could not renew advance premium tax credits (APTC) or cost-sharing reductions (CSRs) for the next year unless you, or the person who filed your application, provide or confirm household income and family size, U.S. citizenship or eligible immigration status, eligibility for or enrollment in other coverage, and place of residence on or after August 1 and no later than December 31 before the plan year. (Proposed rule, section I.B; proposed § 155.335)
• No advance premium help during certain data mismatches. If your application has a “data matching issue” (the Marketplace can’t confirm what you reported) on citizenship or lawful presence, residency, other coverage, income or family size, or employer coverage, the Marketplace could not pay APTC or CSRs until the issue is resolved. Today, people with a data matching issue can generally keep getting premium help based on their application while they have 90 days (95 days for citizenship or immigration status) to send documents. The rule would not apply if you qualify for the special enrollment periods for gaining a dependent (marriage, birth, adoption, foster care or court order) or losing one (divorce, legal separation or death). (Proposed rule, sections I.B, II and III.A; proposed § 155.315(f)(4))
• A way to “pend” your plan. Marketplaces would have to let you hold your plan selection so coverage starts only after you are found eligible for premium help, so you are not billed full price in the meantime. (Proposed rule, section I.B; proposed § 155.400(i))
• New start dates when documents are late. In general, if all of your data matching issues are resolved by the 15th of the month after your normal coverage start date, you keep that start date. If not, coverage starts the first of the month you resolve them (by the 15th) or the first of the next month (if resolved from the 16th on). (Proposed rule, section I.B)

CMS also asks for ideas on how Marketplaces could rely less on self-attestation for residency and family size, and whether people who apply for Medicaid or CHIP during the pre-enrollment period and are denied should get a special enrollment period. (Proposed rule, section I.B)

Who it affects

• People who buy health insurance on HealthCare.gov with premium tax credits. South Carolina uses the federally facilitated Marketplace, HealthCare.gov. (SC Department of Insurance) All Marketplaces would have to offer the new “pend” option, and HealthCare.gov would be required to offer retroactive enrollment in certain cases. (Proposed rule, section I.B)
• Enrollment numbers. CMS estimates enrollment would drop by 237,500 people a year on the federal platform and 95,000 in state-run Marketplaces, and that average premiums would rise 0.4% ($2.89 per member per month) starting in 2028 because younger and healthier people would leave. It estimates advance premium tax credit spending would fall by $7.6 billion a year starting in 2028. (Proposed rule, Regulatory Impact Analysis)
• People with data matching issues. CMS estimates that people who have a data matching issue and later verify their information would get premium help for 1.5 fewer months on average. (Proposed rule, Regulatory Impact Analysis)

What it means for you

• Nothing changes yet. This is a proposal, and its changes are aimed at 2028 coverage. For 2027 coverage, see our explainer on the IRS premium tax credit proposed rule, which covers the separate repayment changes and this fall’s open enrollment dates.
• If it is finalized, plan to confirm your income, household and other details with HealthCare.gov each year starting August 1, or your plan could renew without premium help. (Proposed rule, proposed §§ 155.335 and 155.410(h)) CMS notes some people who are renewed without premium help may not be able to pay the full premium and could lose coverage for nonpayment. (Proposed rule, section III.A)
• Answer document requests quickly. Under the proposal, premium help would start only after a data matching issue is resolved. (Proposed rule, proposed § 155.315(f)(4))
• Comment if you want to. Comments go to regulations.gov, docket CMS-2026-3367, or by mail to CMS, Attention: CMS-9873-P, P.O. Box 8016, Baltimore, MD 21244-8016. They are due 30 days after the rule is published in the Federal Register. (Proposed rule, Dates and Addresses)

Current status

Filed for public inspection October 23, 2026, and scheduled for publication in the Federal Register October 27, 2026 (FR Doc. 2026-21891, CMS-9873-P, RIN 0938-AW03). It is a proposed rule and is not final. (Proposed rule, header)

What happens next

CMS will take comments for 30 days after publication, then decide whether to issue a final rule. The law’s verification requirement applies to tax years beginning after December 31, 2027, and the verification process must be in place by August 1, 2027. (Proposed rule, Dates and section II)

Sources

• Federal Register: “Patient Protection and Affordable Care Act, Exchange Pre-Eligibility Verification,” CMS proposed rule, FR Doc. 2026-21891 (filed Oct. 23, 2026; publication Oct. 27, 2026)
• S.C. Department of Insurance: Affordable Care Act

Every statement above is drawn from the official source text linked here; section references are shown in grey. This is a plain-English summary, not legal advice. Spot an error? Tell us.