The Biden administration has finalized new Affordable Care Act (ACA) regulations that aim to broaden insurance options but may result in a decline in overall enrollment. The changes, announced in mid-May 2026 and set to take effect over the next two years, introduce alternative health plans with higher out-of-pocket costs and nonnetwork coverage models, alongside stricter eligibility verification measures.

Among the key provisions is the introduction of plans without defined networks of doctors and hospitals, beginning in 2028. These “nonnetwork plans” require enrollees to seek providers who agree to accept the insurer’s payment as full reimbursement for nonemergency care. Regulators contend that this approach encourages consumers to shop for lower prices and negotiate directly with providers, potentially reducing healthcare spending. However, experts warn that this model places significant responsibility on consumers to ensure their providers participate and to understand potential financial risks. Critics also raise concerns that the plans could undermine ACA safeguards by limiting access to listed providers and complicating care. Views on the change are mixed, with some conservative think tanks noting that increased pricing transparency could empower consumer choice.

Another significant modification allows insurers to offer bronze-tier plans with up to 30 percent higher maximum out-of-pocket limits starting in 2027. This adjustment potentially raises individual deductibles to as much as $15,600 and family deductibles to $31,200. Similar increases will apply to catastrophic plans beginning in 2028, which are primarily available to people under 30 or those ineligible for premium subsidies. While these plans may feature lower premiums, they expose enrollees to higher upfront costs before insurance coverage begins, a risk experts say may deter many due to low average savings among Americans.

The rule also incorporates expanded verification requirements for subsidy eligibility and special enrollment periods. Beginning next year, applicants must provide additional documentation to confirm income and qualifying life events such as job loss or marriage to reduce fraudulent sign-ups. Moreover, premium tax credits will be denied to individuals who fail to file tax returns for one year, tightened from the previous two-year standard. These added administrative steps, while projected to save the government an estimated $1.3 billion annually, are expected to create barriers that could depress marketplace participation by up to 2 million people in 2027, compounding anticipated enrollment declines driven by rising premiums and reduced subsidies.

Legal challenges have partially delayed implementation of prior rules on special enrollment verification, but the administration intends to reinstate them with the upcoming regulation. Advocates argue that these measures will curb fraud and protect program integrity, whereas consumer advocates caution they will exacerbate affordability and access challenges amid an ongoing healthcare cost crisis.

The Centers for Medicare & Medicaid Services characterized this year’s final rule as one of the most comprehensive in recent memory, reflecting adjustments required by legislative changes enacted last year as well as evolving plan design and marketplace oversight priorities. While the administration projects the changes will increase consumer choice and encourage cost-conscious behavior, health policy analysts underscore the risks that higher out-of-pocket expenses and additional eligibility requirements may place coverage out of reach for vulnerable populations, potentially eroding the ACA’s progress in expanding access to affordable health insurance.