The Centers for Medicare & Medicaid Services (CMS) recently released the final rule for the 2027 Notice of Benefit and Payment Parameters, related to, among other things, the Affordable Care Act Marketplace plans. These plans cover more than 20 million Americans. The final rule provisions become effective on July 20, 2026.
In March this year, the Policy Center for Maternal Mental Health (“Policy Center”) submitted proposed rule comments to CMS, urging the agency to address Marketplace plan enrollment for pregnant individuals and affordability of maternity and pediatric care. Specifically, we recommended:
- “Pregnancy, labor and delivery and postpartum care (‘maternity care’), as well as pediatric primary care for births covered by the plan, should be provided at zero cost share. This provision should apply to all plans offered on the exchange, including catastrophic plans.”
- “Pregnancy itself should also be classified as a qualifying event.”
Our comments centered on the impact of rising high deductible plan out-of-pocket costs for maternity and pediatric primary care and restrictive annual enrollment periods rather than continuous enrollment for pregnancy as a “qualifying event”. We noted the Administration has raised the United States is facing low birth rates and persistent maternal health challenges. We also noted that health coverage should incentivize healthy pregnancies not serve as a financial barrier to care.
Specifically the final rule allows health plans to offer higher-deductible plans, along with increased maximum out-of-pocket limits (before insurance coverage kicks-in).
Catastrophic plans (those with very low premiums and very high deductibles to cover serious illness or accidents) are now also allowed to be offered to those under age 30 before the plan year begins, those 30 or older with a certified financial hardship or affordability waiver and those ineligible for subsidies due to specific low-income or high-income brackets.
The final rule also requires additional enrollment verification requirements, such as documentation to prove qualification for special enrollment periods, subsidies, or certain coverage options.
While the final rule may technically provide more ACA marketplace plan options, it does not address pregnancy as a qualifying life event for a special enrollment period, nor provide zero-cost maternity and pediatric care.
Those pregnant and young families who do enroll in these new plans will face more administrative complexity and higher financial strain. This will impact access to timely prenatal care and increase financial stress during pregnancy and the postpartum period.
The Administration and CMS must ensure ACA Marketplace plans provide maternity and pediatric primary care without cost-sharing and recognize pregnancy as a qualifying life event for Marketplace enrollment.
These changes will help reduce barriers to care, and better support the health and economic stability of American families.
