Direct answer: On October 23, 2026, the Centers for Medicare & Medicaid Services (CMS) proposed a rule (CMS-9873-P) that would require Affordable Care Act (ACA) marketplaces to verify four eligibility items before paying premium subsidies, starting with plan year 2028. The public comment deadline is November 27, 2026. This is a proposed rule, not a final rule, and it does not change 2027 open enrollment, which runs November 1, 2026 through January 15, 2027.
What is changing, and what stays the same?
Today, when a marketplace cannot confirm something on an application electronically, the applicant enters an inconsistency period and generally keeps receiving advance premium tax credits (APTC) and cost-sharing reductions (CSRs) while they submit documents. Under current rules, that period is generally 90 days for income questions and 95 days for citizenship or immigration status questions.
The proposal would reverse that order for plan year 2028: financial assistance would start only after the listed items are verified. If verification is still pending, a person could still enroll, but without financial assistance until eligibility is confirmed. CMS also proposes that, for people already enrolled when verification succeeds, financial assistance would apply retroactively for the months they were enrolled during the inconsistency period.
What are the 4 things that must be verified first?
Under the proposed rule, marketplaces would have to verify these four criteria before providing advance premium tax credits or cost-sharing reductions:
| Item to verify | What it covers |
|---|---|
| 1. Household income and family size | The income and household size used to calculate financial help |
| 2. Citizenship or eligible immigration status | Status as a citizen, U.S. national, or eligible noncitizen, including lawfully present immigrants |
| 3. Other qualifying coverage | Eligibility for or enrollment in other coverage, such as Medicaid or a job-based plan |
| 4. Place of residence | Where the applicant lives |
What happens if your information cannot be verified right away?
Three options in the proposal are worth knowing:
- Enroll without assistance while verification is pending. Coverage can start, but the premium is paid without subsidies until verification clears.
- Choose a contingent plan. A plan selection that becomes effective only if the person is found eligible for financial assistance, even if open enrollment has ended by then.
- Receive retroactive assistance once verified. For people already enrolled, CMS proposes that financial assistance would cover the months of enrollment during the inconsistency period once eligibility is confirmed.
One proposed exception: for certain family-size changes, such as birth, adoption, marriage, or loss of a dependent through divorce, separation, or death, CMS proposes waiving the new verification requirements so financial assistance is based on the attested application information during inconsistency periods.
What changes for people who auto-renew?
Under the proposal, currently enrolled consumers would only be automatically re-enrolled with financial assistance if they return to the marketplace each year to confirm certain eligibility criteria and have them re-verified. People who do not return and have their information re-verified would be automatically re-enrolled without financial assistance. In other words, passive renewal would no longer be enough to keep subsidies in place.
What is the August 1 early verification window?
CMS proposes a pre-open-enrollment verification period starting August 1 each year, so people can submit eligibility information early and have it verified before the next coverage year. The first window would start August 1, 2027, for 2028 coverage. The idea is to give people time to gather documents before open enrollment, rather than resolving mismatches after coverage starts.
What can you do now?
- For 2027 coverage, shop as usual. This proposal does not affect the 2027 open enrollment window (November 1, 2026 to January 15, 2027). Enroll by December 15, 2026 for coverage starting January 1, 2027.
- Keep your documents in one place. Income records, household information, proof of residence, and information about any other coverage are the four areas the proposal targets.
- Mark August 1, 2027. That is the proposed start of the first early verification window for 2028 coverage.
- Comment by November 27, 2026, if you want your view on record. Comments on proposed rule CMS-9873-P can be submitted through Regulations.gov (docket CMS-2026-3367) or by mail to CMS at the addresses in the Federal Register notice.
Frequently asked questions
Does this proposal affect my 2027 health plan?
No. The proposed requirements would be effective starting with eligibility determinations for plan year 2028. The 2027 open enrollment period is not changed by this proposal.
Is this rule final?
No. It is a proposed rule published in the Federal Register on October 27, 2026. CMS must review public comments before issuing a final rule, and the proposal could change.
What if my documents take time to gather?
The proposal adds the August 1 early verification window for that reason, and the contingent-plan option lets a plan choice take effect once eligibility is confirmed, even after open enrollment ends.
Where can I check my own situation?
HealthCare.gov and your state marketplace publish document guides and application checklists. A licensed navigator or broker can help with an individual application.
Key takeaway
Starting with 2028 plans, CMS proposes a "verify first, then subsidies" order for ACA marketplaces: income and family size, citizenship or eligible immigration status, other coverage, and residence would all need to be confirmed before premium tax credits and cost-sharing reductions are paid. The change would not touch 2027 enrollment, but it would end subsidy payments during unresolved verification mismatches and require an annual return to the marketplace to keep subsidies on renewal. The first early verification window would open August 1, 2027, and public comments are due November 27, 2026.
Sources
- CMS fact sheet: Exchange Pre-Eligibility Verification Proposed Rule (CMS-9873-P), published October 23, 2026 — https://www.cms.gov/newsroom/fact-sheets/exchange-pre-eligibility-verification-proposed-rule-cms-9873-p
- Federal Register, Patient Protection and Affordable Care Act, Exchange Pre-Eligibility Verification (CMS-9873-P), published October 27, 2026; comments due November 27, 2026 — https://www.federalregister.gov/public-inspection/2026-21891/patient-protection-and-affordable-care-act-exchange-pre-eligibility-verification
- CMS press release, October 23, 2026 — https://www.cms.gov/newsroom/press-releases/cms-proposes-new-verification-requirements-implement-law-combats-exchange-fraud-protects-taxpayer
This post was created with the help of AI and is for general information only. It is not medical, legal, or financial advice, and it does not replace guidance from a licensed professional, a marketplace navigator, or an official source such as HealthCare.gov or CMS. If a detail affects your coverage or your premium, please confirm it with the marketplace or a qualified professional before acting.
