Article
The core proposals
CMS released its proposed Notice of Benefit and Payment Parameters for 2027 on Feb. 9, and it was published in the Federal Register on Feb. 11. Several provisions change how marketplace plans would interact with hospitals:
- Non-network plans. Starting in plan year 2027, plans without a provider network could be certified as qualified health plans. Instead of contracting, the plan would set a benefit amount for each covered service and must show enrollees can reach a range of providers that accept that amount as payment in full, including essential community providers and behavioral health providers.
- Lower safety-net threshold. The share of essential community providers an issuer must contract with in each service area would drop from 35% to 20%, and the narrative justification for falling short would be eliminated.
- More state control of networks. State-based exchanges would no longer have to adopt time and distance standards at least as strict as the federal ones.
- Longer catastrophic plans. Catastrophic coverage could run for up to 10 consecutive years.
- No standardized options. Issuers on federal platforms would no longer have to offer standardized plans, and limits on non-standardized plans would end.
Why it matters to hospitals
Non-network plans would shift negotiating leverage. A hospital that does not accept the plan’s benefit amount could leave patients with balances they cannot pay, which tends to show up as bad debt or charity care. A hospital that does accept it is effectively taking a price set by the insurer without a contract. Either way, finance teams will need to understand how those amounts compare with their current marketplace rates.
The lower essential community provider threshold matters most to safety-net and teaching hospitals, which rely on that requirement for inclusion in narrow marketplace networks. A 20% floor gives issuers more room to leave them out.
The longer catastrophic terms and greater plan design flexibility point toward more enrollees in high-deductible products. That raises the share of each bill collected from patients, which pressures point-of-service collections and financial assistance programs.
What to do before comments close
- Model what share of your marketplace volume could migrate to non-network or catastrophic products.
- Estimate how a plan-set benefit amount might compare with your contracted marketplace rates.
- If you are an essential community provider, document your role in local networks and share it with your hospital association.
- Submit comments, directly or through associations, by March 13.
Archive entry for Feb 15, 2026, added Nov. 11, 2026.