Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability

Status: In force. The effective date has passed and nothing here records a change to that.

From the published effective date. Nothing here records a court changing it.

• Document number: 2025-11606
• Type: Final Rule
• Published: June 25, 2025
• Effective: August 25, 2025
• Agency: Health and Human Services Department

Official abstract

This final rule revises standards relating to denial of coverage for failure to pay past-due premium; excludes Deferred Action for Childhood Arrivals recipients from the definition of "lawfully present;" establishes the evidentiary standard HHS uses to assess an agent's, broker's, or web-broker's potential noncompliance; revises the Exchange automatic reenrollment hierarchy; revises standards related to the annual open enrollment period and special enrollment periods; revises standards relating to failure to file and reconcile, income eligibility verifications for premium tax credits and cost-sharing reductions, annual eligibility redeterminations, de minimis thresholds for the actuarial value for plans subject to essential health benefits (EHB) requirements, and income-based cost-sharing reduction plan variations. This final rule also revises the premium adjustment percentage methodology and prohibits issuers of coverage subject to EHB requirements from providing coverage for specified sex-trait modification procedures as an EHB.

Primary source

Read the full text on the Federal Register

This page is a structured index entry, not a substitute for reading the rule. This is not legal advice.

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Data updated October 2, 2026