ACA Notice of Benefit and Payment Parameters

Current understanding

Annual HHS rulemaking that sets the operating parameters for ACA individual and small group markets, including risk adjustment methodology, Qualified Health Plan (QHP) certification standards, Exchange user fee rates, hardship exemptions, catastrophic plan rules, and Basic Health Program payment calculations. HHS has finalized the 2027 parameters, updating risk adjustment, expanding hardship exemptions, extending catastrophic plan terms, and revising BHP payment calculations — changes that affect issuer premiums, plan availability, and consumer eligibility for coverage relief.

Evidence log

• 2025-01-22 — No Taxpayer Funding for Abortion and Abortion Insurance Full Disclosure Act of 2025: cross-connection with abortion-federal-funding-restrictions: Bill would restrict abortion coverage in ACA qualified health plans, intersecting with ACA benefit/payment rules governing QHP-covered services. (novelty: 3)

Open questions

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