Skip to main content


U.S. flag
      An official website of the United States government
              Here’s how you know
        Here’s how you knowDot gov**Official websites use .gov**
                 A **.gov** website belongs to an official government organization in the United States.
                  HTTPS**Secure .gov websites use HTTPS**
                 A **lock** (A locked padlock) or **https://** means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites. 
  Menu Close
          Enter the terms you wish to search for.
    Search
        








  
  
    

  
      

                                      About HHS
    
                        
                              
      
      
      Programs & Services
    
                        
                              
      
      
      Grants & Contracts
    
                        
                              
      
      
      Laws & Regulations Breadcrumb
    Home
                              About
                              News
                              HHS Finalizes Policies to Make Marketplace Coverage More Accessible and Expand Essential Health Benefits
 Navigate to:
  News
    
                                    
                                            
            
      
      
      
      Blog
    
                                    
                                            
            
      
      
      
      HHS Live
    
                                    
                                            
            
      
      
      
      Podcasts
    
                                    
                                            
            
      
      
      
      Media Guidelines for HHS EmployeesText resize icon

                    




**FOR IMMEDIATE RELEASE April 2, 2024**

        **Contact:
            HHS Press Office 
              202-690-6343media@hhs.gov**

          HHS Finalizes Policies to Make Marketplace Coverage More Accessible and Expand Essential Health Benefits
    
    

      Today, the Biden-Harris Administration, through the U.S. Department of Health and Human Services (HHS)’s Centers for Medicare & Medicaid Services (CMS), announced policies for the Affordable Care Act Marketplaces that make it easier for low-income people to enroll in coverage, provides states the ability to increase access to routine adult dental services, and sets network adequacy standards for the time and distance people travel for appointments with in-network providers. Finally, the rule will standardize certain operations across the Marketplaces to increase reliability and consistency for consumers. The 2025 Notice of Benefit and Payment Parameters final rule builds on the Administration’s previous work expanding access to quality, affordable health care and raising standards for Marketplace plans nationwide.

“More than 21 million Americans signed up for high-quality, affordable health care coverage through the ACA Marketplaces in 2024. We want to build on this success to make Marketplace plans even better,” said HHS Secretary Xavier Becerra. “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.”

“Access to affordable, quality health care options remain a concern across the country and a top priority for CMS,” said CMS Administrator Chiquita Brooks-LaSure. “This rule includes groundbreaking ways to access health care services - such as addressing barriers for routine adult dental coverage for the first time and including considerations for how far people travel to see a health care provider. At CMS, we continue to explore ways to help Americans access high-quality coverage through the ACA Marketplaces.”

**Increasing Access to Health Care Services***Adult Dental Services*

CMS has expanded access to dental benefits by finalizing measures to allow states the option to add routine adult dental services as an essential health benefit (EHB). For the first time, and starting on January 1, 2027, every state will be able to update their EHB-benchmark plans to include routine non-pediatric dental services, such as cleanings, diagnostic X-rays, and restorative services like fillings and root canals, through the EHB-benchmark application process beginning in 2025.

*Network Adequacy*

The final rule creates more consistent, nationwide standards on how far and how long a consumer must travel to see various types of providers in State Marketplaces and State-based Marketplaces on the Federal Platform (SBM-FPs). State Marketplaces and State-based Marketplaces must review a plan’s network information prior to certifying any plan as a qualified health plan (QHP), consistent with the reviews conducted by the Federally-facilitated Marketplaces (FFMs).

**Making It Easier to Enroll in Coverage***Special Enrollment Periods*

The rule extends the special enrollment period (SEP) for consumers with household incomes at or below 150% of the FPL (for the 2025 plan year, $38,730 for a family of three) to enroll in coverage in any month rather than only during Open Enrollment. Previously, this SEP was only available when enhanced subsidies under the IRA were available.

The rule also aligns the dates of Open Enrollment periods across almost all Marketplaces to generally begin on November 1 and end no earlier than January 15, with the option to extend the Open Enrollment period beyond January 15.

Additionally, the rule aims to prevent coverage gaps for those transitioning between different Marketplaces or from other insurance coverage by allowing those selecting coverage during certain SEPs to receive coverage beginning the first day of the month after the QHP is selected, as opposed to coverage beginning at a later date if the consumer enrolls between the 15th and the end of the month.

*Streamlining the Enrollment Process*This rule includes multiple policies to standardize operations among the Federally-facilitated and State-based Marketplaces to ensure a more streamlined consumer experience, such as requiring Marketplaces to have live call center representatives available during call center hours of operation to assist consumers with QHP application submission and enrollment, generally holding Open Enrollment from November 1-January 15 (with the option for Marketplaces to extend Open Enrollment to a later date), and automatically re-enrolling people who are enrolled in a catastrophic plan for the next year, in order to prevent gaps in coverage.

For more information on the final rule, see the fact sheet at https://www.cms.gov/newsroom/fact-sheets/hhs-notice-benefit-and-payment-parameters-2025-final-rule

Click here to view the final rule: https://www.cms.gov/files/document/cms-9895-f-patient-protection-final.pdf
  

    ###
    Note: All HHS press releases, fact sheets and other news materials are available at https://www.hhs.gov/news.Like HHS on Facebook, follow HHS on Twitter @HHSgov, and sign up for HHS Email Updates.Last revised: April 2, 2024

  
  
  







  Sign Up for Email Updates

Receive the latest updates from the Secretary, Blogs, and News Releases

Sign Up







  Subscribe to RSS
    

      Receive latest updates







  Related News Releases
    

      CMS Proposes New Policies to Support Underserved Communities, Ease Drug Shortages, and Promote Patient Safety
  

Biden-Harris Administration Finalizes Rule Expanding Access to Care and Increasing Protections for People with Medicare Advantage and Medicare Part D
  

HHS Releases White Paper Focused on Preventing Drug Shortages

                    
  


Media Inquiries

For general media inquiries, please contact media@hhs.gov.







  Content created by Assistant Secretary for Public Affairs (ASPA) Content last reviewed April 2, 2024 Back to top
    Contact HHS
    
                        
                                            
      
      
      Careers
    
                        
                                            
      
      
      HHS FAQs
    
                        
                                            
      
      
      Nondiscrimination NoticeHHS Archive
    
                        
                                            
      
      
      Accessibility
    
                        
                                            
      
      
      Privacy Policy
    
                        
                                            
      
      
      Viewers & PlayersBudget/Performance
    
                        
                                            
      
      
      Inspector General
    
                        
                                            
      
      
      Web Site Disclaimers
    
                        
                                            
      
      
      EEO/No Fear ActFOIA
    
                        
                                            
      
      
      The White House
    
                        
                                            
      
      
      USA.gov
    
                        
                                            
      
      
      Vulnerability Disclosure Policy
        Sign Up for Email Updates

Receive the latest updates from the Secretary, Blogs, and News Releases.

Sign Up
  HHS Headquarters
          200 Independence Avenue, S.W.
                  Washington, D.C. 20201
                  Toll Free Call Center: 1-877-696-6775​