New HHS Rule Expands Healthcare Access and Enhances Marketplace Guidelines

The U.S. Department of Health and Human Services (HHS) recently introduced the 2025 Notice of Benefit and Payment Parameters final rule, which pushes the Biden-Harris Administration’s ongoing efforts to expand access to quality, affordable healthcare and elevate guidelines for health insurance marketplace (Marketplace) plans nationwide.

CMS joined the initiative and finalized guidelines for issuers and Marketplaces, as well as requirements for various entities assisting Marketplace consumers, affecting programs such as Medicaid, CHIP, and BHP policies, according to CMS.

The efforts of the final rule aim to simplify the enrollment process for low-income consumers, provide states with more flexibility in offering routine adult dental services and set guidelines to create access to in-network providers, per an HHS press release.

In the release, HHS Secretary Xavier Becerra shared that more than 21 million Americans signed up for high-quality, affordable healthcare coverage through the Affordable Care Act Marketplaces in 2024.

“This rule will allow coverage of routine dental benefits for the first time, expand requirements to ensure reliable access to health care providers, and ensure consumers with lower incomes can sign up for coverage when they need it,” Becerra said.

Below are the key advancements of the final rule, per HHS:

• Expanding Access to Health Services
  CMS has expanded dental coverage by allowing states to add routine adult dental services as an essential health benefit.
  
  Beginning January 1, 2027, states can update their health benefit benchmark plans to include services such as cleanings and fillings. This aims to improve dental care accessibility across states.
  
• Network Guidelines
  The final rule establishes consistent guidelines to ensure sufficiency of healthcare provider networks in State and Federal Marketplaces. Marketplaces must then review a plan's network information before certifying it as a qualified health plan (QHP).
  
  This step guarantees consumers have access to various providers within reasonable distances.
• Enrollment Simplification
  The rule extends special enrollment periods for low-income households and aligns Open Enrollment periods across most Marketplaces, beginning November 1 to January 15.
  
  The rule also allows coverage to begin the first day of the month after selection during special enrollment periods, aiming to prevent coverage gaps.
  
  Lastly, it mandates streamlined enrollment processes to improve consumer experience.