The Trump administration has finalized a wide-ranging set of changes to the Affordable Care Act that will introduce new plan options with higher out-of-pocket costs and no fixed networks of doctors and hospitals, starting in 2027 and 2028. The final rule, issued in mid-May, aims to expand consumer choice but could reduce enrollment by up to 2 million people next year, according to government estimates.
The changes come amid ongoing debates over the ACA's future and affordability.
Starting in 2028, some ACA consumers will be able to purchase non-network plans that do not have dedicated provider networks. Instead, enrollees must find doctors and hospitals willing to accept the insurer's payment as full reimbursement for nonemergency care.
Regulators say this model encourages shopping for lower prices, but experts warn it could leave patients with surprise bills if providers charge more than the plan pays. The rule requires insurers to ensure a sufficient choice of providers, but details on monitoring are unclear.
Another major change allows insurers to offer bronze and catastrophic plans with out-of-pocket maximums up to 30% higher than current limits. For 2027, bronze plan maximums could reach $15,600 for individuals and $31,200 for families.
Catastrophic plans, available to those under 30 and those without premium subsidies, must adopt these higher limits starting in 2028. These plans cover only preventive services and up to three primary care visits before deductibles apply.
Critics say the higher costs could financially strain enrollees, many of whom have limited savings.
The rule also tightens eligibility verification, requiring more documentation for special enrollment periods, such as marriage or loss of job-based coverage. Premium tax credits will be denied to people who haven't filed taxes for one year, down from the previous two-year threshold.
Supporters argue these measures reduce fraud, but opponents say they create barriers that could depress enrollment.
Lawsuits from cities and other plaintiffs have challenged similar provisions from a 2025 rule, with some courts blocking changes. The new rule seeks to restore those provisions, but legal challenges continue.
Health policy analysts like Katie Keith of Georgetown University warn that the combined effect of these changes will significantly erode marketplace access and affordability, especially for lower-income consumers. The rule also implements adjustments from the One Big Beautiful Bill Act passed by Congress last year.