On October 27, 2026, CMS published a proposed rule that would generally stop Exchanges from authorizing advance premium tax credits and cost-sharing reductions while certain data-matching issues remain open. Consumers could still enroll in a plan without those subsidies until verification is finished. Comments are due November 27, 2026. The rule is proposed, not final.
Key facts: The proposal implements verification requirements in section 71303 of Public Law 119-21 (the Working Families Tax Cut legislation) and would amend 45 CFR Part 155. · For plan year 2028, Exchanges would run a pre-open-enrollment verification window beginning August 1, 2027, under the proposal. · People could still enroll in Marketplace coverage during an inconsistency period; the proposed change is about when APTC and CSRs can be paid, not about blocking plan enrollment entirely.
On October 27, 2026, the Centers for Medicare & Medicaid Services published a proposed rule in the Federal Register that would change when Affordable Care Act Marketplaces can start paying advance premium tax credits (APTC) and cost-sharing reductions (CSRs).
As of today, Friday, November 6, the proposal is still open for public comment through November 27, 2026. It is not final policy.
What Would Change
Today, when an Exchange finds a data matching issue (DMI) — for example, income or citizenship information that does not line up with trusted data sources — many applicants can still get APTC and CSRs during a 90- or 95-day inconsistency period while they submit documents, if they otherwise qualify based on their application.
The proposed rule would generally stop Exchanges from authorizing APTC and CSRs for applicants with DMIs tied to specified “applicable enrollment information” until those issues are resolved and eligibility is verified. The Federal Register summary points to checks covering areas such as:
- Household income and family size
- Citizenship or lawful presence / eligible noncitizen status
- Other minimum essential coverage
- Residency
- Employer-sponsored coverage, where relevant
CMS frames the change as implementing section 71303 of Public Law 119-21 (described in the rule as the Working Families Tax Cut legislation), which amends Internal Revenue Code section 36B so that, starting with tax years after December 31, 2027, a month generally is not a “coverage month” for premium tax credit purposes until an Exchange verifies specified enrollment information.
You Could Still Enroll — Without the Subsidy, for a While
The proposal draws a line between enrolling in a plan and getting financial help.
CMS proposes that applicants could still be found eligible to enroll in a qualified health plan during an inconsistency period, if otherwise eligible. Section 36B(c)(5)(D) of the Code, as discussed in the rule, says a person must not be treated as ineligible to enroll in a QHP solely for failing the new verification timing rules. In plain terms: the front-end change is aimed at when subsidies start, not at locking people out of buying coverage entirely.
The rule also proposes ways to “pend” a plan selection until subsidy eligibility is resolved, plus new effective-date rules for when APTC and CSRs begin after verification — including, in some cases, retroactive subsidy months once verification is complete, subject to the details in the proposal.
Timing: Aimed at Plan Year 2028
Under the proposal, the new verification approach is tied to plan year 2028. CMS also proposes that all Exchanges provide a pre-open-enrollment verification period beginning each year on August 1 — starting August 1, 2027 for 2028 coverage — so people can submit and begin verifying eligibility information before open enrollment starts.
Annual redetermination rules would also change under the proposal: an Exchange generally could not redetermine someone eligible for APTC and CSRs for the next plan year unless the enrollee confirms key facts on or after August 1 and by December 31 of the prior year, and the Exchange attempts verification.
The Fine Print: This is a proposed rule (CMS-9873-P). Nothing in it is binding until CMS finalizes it, and the final version can differ from the draft. The Federal Register notice asks for comments by November 27, 2026, including through Regulations.gov.
What This Means for You
This is general education, not advice:
- If you use Marketplace subsidies now, the proposal would matter mainly for 2028 coverage and the summer/fall 2027 verification window — and only if finalized as proposed.
- Open enrollment for 2027 coverage is a separate process running now on HealthCare.gov and state Marketplaces; this proposed rule does not rewrite that calendar by itself.
- Want to weigh in? The comment deadline is November 27, 2026. The official docket is CMS-2026-3367 / file code CMS-9873-P.
Have a question about Marketplace subsidies or verification notices? Send it to us, and we may explain it in a future article.
This article is general education, not legal, tax, insurance or financial advice. It summarizes a proposed federal rule and does not predict the final text. Check HealthCare.gov, your state Marketplace and the Federal Register for your situation.
Sources:
- Federal Register: Patient Protection and Affordable Care Act, Exchange Pre-Eligibility Verification (CMS-9873-P, Oct. 27, 2026)
- Regulations.gov docket CMS-2026-3367
Frequently asked questions
Is this rule already in effect?
No. It is a proposed rule published in the Federal Register on October 27, 2026. It does not take effect unless finalized. Comments are due November 27, 2026.
Would people be blocked from buying Marketplace coverage?
Under the proposal, applicants could still be determined eligible to enroll in a qualified health plan during many inconsistency periods. The main change is that APTC and cost-sharing reductions generally would wait until specified eligibility information is verified.
