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Published by Affordable Care Agents | August 2025

On August 22, 2025, the U.S. District Court for the District of Maryland issued a nationwide stay (pause) on several provisions of the 2025 Marketplace Integrity & Affordability Final Rule. The order came as part of the lawsuit City of Columbus et al. v. Kennedy et al. and means that certain policy changes scheduled to take effect are on hold until further court action.

This development has important implications for brokers, agents, and consumers preparing for the 2026 Open Enrollment Period.

What’s Paused — and What It Means for Brokers

Here are the provisions currently paused by the court, along with what that means in practice:

  1. $5 Monthly Premium Responsibility

    • Original rule: Certain consumers in $0 premium plans would have been charged $5/month if they didn’t actively update their eligibility.

    • Now: No $5 charge. Clients in $0 premium plans continue without added costs.

  2. Past-Due Premium “Satisfaction of Debt”

    • Original rule: Insurers could require payment of past-due premiums before effecting new coverage.

    • Now: Carriers cannot deny new coverage based on past-due premiums under this rule.

  3. Failure to File & Reconcile (FTR) – One-Year Cutoff

    • Original rule: Consumers would lose eligibility for subsidies (APTC) after one year of failing to file/reconcile taxes.

    • Now: Paused. The prior two-year standard remains.

  4. Marketplace SEP Eligibility Verification

    • Original rule: Required marketplaces to verify eligibility for all Special Enrollment Periods (SEPs) before enrollment.

    • Now: SEP verification stays as-is. No added hurdles for brokers or consumers.

  5. Income Verification When Tax Data is Unavailable

    • Original rule: Self-attestation could no longer be used if IRS data was missing.

    • Now: Attestation exception still allowed.

  6. Income Verification Conflicts

    • Original rule: Additional verification required whenever self-attested income conflicted with “trusted data sources.”

    • Now: Existing processes remain in place.

  7. Actuarial Value (AV) De Minimis Range Adjustments

    • Original rule: Would have narrowed flexibility for plan design and metal-tier values.

    • Now: Current AV standards remain unchanged.

What’s Not Paused

Other provisions of the 2025 Final Rule remain on schedule, including:

  • End of the Low-Income Monthly SEP (≤150% FPL) — slated to expire for Plan Year 2026.

  • Agent/Broker Oversight Standard — CMS codified a “preponderance of the evidence” standard for terminations.

  • Open Enrollment Dates for Plan Year 2027 — standardized to Nov 1 – Dec 15 on the Federally Facilitated Marketplace (FFM).

Why This Matters for Brokers

The pause means no immediate changes to how you assist clients during SEP enrollments, subsidy eligibility, or income verification. This helps reduce confusion for both consumers and agents heading into Open Enrollment.

Key positives right now:

  • No surprise $5 charges on $0 premium plans.

  • No sudden subsidy losses due to a stricter one-year FTR rule.

  • No additional SEP verification steps.

  • More stability for carriers and plan designs.

Looking Ahead

This case will continue through the courts, and CMS has signaled it will provide updates as rulings develop. Brokers should:

  1. Continue using current processes for SEPs, income verification, and tax filing/reconciliation.

  2. Educate clients that while stricter rules were proposed, they are on hold — but encourage tax compliance and timely updates to avoid issues.

  3. Prepare for PY 2026 as though the low-income monthly SEP will end unless future court action changes this.

  4. Stay alert for CMS guidance that may adjust timelines if the stay is lifted or modified.

Final Takeaway

The pause on these provisions offers some relief to both brokers and consumers, preventing sudden disruptions in eligibility and enrollment processes. However, other major policy changes in the Final Rule are still scheduled to take effect, and ongoing litigation could shift timelines again.

Affordable Care Agents will continue to monitor developments closely and provide timely updates to ensure you and your clients are prepared.

📌 For questions or compliance guidance, visit AffordableCareAgents.com or contact our broker support team.