Exchanges
Exchange User Fees
An exchange user fee is a percentage of premiums that are collected to fund exchange activities. Annually, HHS sets separate user fees for FFEs and SBE-FPs.
The FFE user fee was proposed to be 2.5% of total monthly premiums for benefit year 2026, and 2.0% for the SBE-FP.[24] However, this assumes that the enhance PTC subsidies will not be extended. If they are extended by the end of March, HHS expects to lower the proposal to between 1.8%-2.2% for the FFE user fee and between 1.4%-1.8% for SBE-FP due to the expectation of higher enrollment. HHS finalized the exchange fee amounts if the expanded subsidies are not extended. HHS further finalized if the enhanced subsidies are extended by July 31, 2025 (as opposed to end of March), the FFE and SBE-SP rates would be the high end of the range proposed, ie 2.2% and 1.8% of monthly premiums respectively.
Assistance with Financial Assistance Programs
HHS noted their concern about the significant outstanding medical bills that are currently in collections. While Assisters and Navigators are available to help consumers make informed decisions about picking their health plan, HHS is soliciting comments about how Assisters and Navigators may be utilized to direct customers to financial assistance programs.[25] They specifically noted assister programs located within hospitals or as part of hospital systems. HHS noted they will take comments into consideration for future rulemaking.
Enforcement for Misconduct or Noncompliance
CMS noted they intend to perform compliance reviews and will take enforcement action against misconduct or noncompliance. While this enforcement would apply to applicable agents, brokers, and web-brokers, they are proposing to extend their authority to lead brokers and agencies.[26] This was finalized as proposed.
CMS noted a significant number of enrollments (640,000) did not identify a specific individual agent or broker but instead used the identification number of an agency only. They also noted that they had found evidence of agencies directing employees to engage in misconduct, for example not speaking to individuals before enrolling them in plans and entering inaccurate income information to result in a zero premium plan, causing problems for the consumer in the tax reconciliation process where they may owe significant dollars.
They are also soliciting comments if they should seek enforcement against individuals (lead agents) allowing other agents to use their identification number while engaging in misconduct.
CMS proposed to include system suspensions as part of their enforcement authority if they discover unacceptable risk to accuracy of eligibility determinations, noncompliance with standards of conduct or privacy and security standards until adequately remedied according to HHS.[27] This was finalized as proposed.
[24] D. Part 156—Health Insurance Issuer Standards Under the Affordable Care Act, Including Standards Related to Exchanges – 2. FFE and SBE–FP User Fee Rates for the 2026 Benefit Year (§156.50)
[25] C. Part 155—Exchange Establishment Standards and Other Related Standards – 1. Solicitation of Comments—Navigator, Non-Navigator Assistance Personnel, and Certified Application Counselor Program Standards (§§155.210, 155.215, and 155.225)
[26] C. Part 155—Exchange Establishment Standards and Other Related Standards -2. Ability of States To Permit Agents and Brokers and Web-Brokers To Assist Qualified Individuals, Qualified Employers, or Qualified Employees Enrolling in QHPs (§155.220) – a. Engaging in Compliance Reviews and Taking Enforcement Actions Against Lead Agents for Insurance Agencies
[27] C. Part 155—Exchange Establishment Standards and Other Related Standards -2. Ability of States To Permit Agents and Brokers and Web-Brokers To Assist Qualified Individuals, Qualified Employers, or Qualified Employees Enrolling in QHPs (§155.220) – b. System Suspension Authority