Marketplace Patients Would Have to Re-Verify Each Year to Keep Subsidies Starting in 2028
An Oct. 23 CMS proposed rule would withhold premium tax credits until income, immigration status and other criteria are verified, and re-enroll without subsidies anyone who skips annual re-verification. The first verification window opens Aug. 1, 2027.
The Centers for Medicare and Medicaid Services proposed on Oct. 23 that, starting with 2028 plans, marketplace enrollees be verified before receiving premium subsidies, and that those who skip annual re-verification lose that help at renewal.
The proposed rule, CMS-9873-P, implements section 71303 of the 2025 budget law the administration calls the Working Families Tax Cuts legislation (Public Law 119-21), also known as the One Big Beautiful Bill Act. It follows the Treasury Department's proposal, published Oct. 15, on the premium tax credit itself. Comments are due 30 days after the rule is published in the Federal Register, which lists it for publication Oct. 27, putting the deadline at about Nov. 26.
What would change for enrollees?
Marketplaces would have to verify household income and family size, citizenship or eligible immigration status, eligibility for other coverage and place of residence before paying advance premium tax credits or income-based cost-sharing reductions, according to the CMS fact sheet. Today, enrollees whose data cannot be matched electronically often keep subsidies during an inconsistency period while they resolve the problem. Under the proposal, that help would stop until verification is complete.
The bigger change may be at renewal. Currently enrolled consumers would be automatically re-enrolled with financial assistance only if they return to the marketplace each year and their information is re-verified. Those who do not would be re-enrolled without help, paying the full premium.
Consumers could still enroll without subsidies while verification is pending. If they are later verified, assistance would be applied retroactively for the months they were enrolled.
The patient who never logs back in to the marketplace is the one most likely to arrive in January 2028 with a plan they can no longer afford.
What are the new dates?
CMS would open a pre-open-enrollment verification window on Aug. 1 each year, beginning Aug. 1, 2027, for 2028 coverage. The proposal also allows contingent plan selection that takes effect only if the consumer is found eligible for financial help. Verification would be waived for certain family-size changes tied to special enrollment periods, including birth, adoption, marriage and loss of a dependent.
The agency gave no estimate of how many people could lose subsidies. CMS Administrator Mehmet Oz, M.D., said in the agency's announcement that "Federal subsidies should only go to eligible Americans, not to fraudsters gaming the system." Treasury Secretary Scott Bessent said taxpayers "should not be forced to subsidize health care for people who are ineligible under federal law."
What practices should watch
Nothing changes for 2027 coverage. The practical risk is in 2028, when patients who miss the annual re-verification may stay enrolled but lose subsidies, then drop coverage after the first unaffordable premium. That pattern resembles the Medicaid churn many practices saw after the end of continuous enrollment, discussed in our look at enrollment churn and your panel.
Practices with large marketplace panels may want to submit comments on how the rule would affect continuity of care, and to plan for front-desk eligibility checks in January 2028 rather than relying on the prior year's card. Health systems with financial counselors can begin planning outreach for the Aug. 1, 2027, window.
Reported, fact-checked and edited by The Script Pad's editorial staff. See How we use AI.
This article is for professional education and does not replace clinical judgment. Treatment decisions should be based on the individual patient and current guidelines.
