What the 2025 Marketplace Integrity Rule Means for You
At Community Access Network, we believe everyone deserves quality healthcare regardless of their insurance status. Part of our mission is keeping you informed about healthcare changes that might affect you and your family. Recently, the Centers for Medicare & Medicaid Services (CMS) proposed new rules that could impact how people enroll in and maintain health insurance coverage. Here’s what you need to know in simple terms.
What’s Happening?
The government has proposed new rules called the “2025 Marketplace Integrity and Affordability Proposed Rule.” While this sounds complicated, it basically means there may be changes to how the Health Insurance Marketplace (healthcare.gov) works.
How Might This Affect You?
Changes to Enrollment Periods
Open Enrollment Period: The proposal would shorten the annual enrollment period to November 1 through December 15 (instead of extending to January 15). This means you would need to sign up for coverage before the holidays if you want insurance for the following year.
Special Enrollment Periods: The rules would make it harder to sign up outside the regular enrollment period. They would remove the monthly enrollment option for people with incomes below 150% of the federal poverty level.
Premium and Payment Changes
$5 Minimum Premium: If you currently pay $0 for your Marketplace plan after subsidies, you might need to pay at least $5 per month until you confirm your eligibility information each year.
Past-Due Premiums: Insurance companies may be allowed to require payment of any past-due premiums before you can enroll in a new plan with them.
Income Verification Changes
The government wants to strengthen how they verify income for individuals receiving subsidies. This could mean:
- More documentation required if your reported income doesn’t match government records
- Less time (90 days instead of 150) to provide proof of income when requested
- Stricter rules if you don’t file taxes and reconcile your premium tax credits each year
Why We’re Sharing This
At Community Access Network, we want you to be prepared for any changes that might affect your healthcare coverage. While these are just proposed rules right now, they could take effect for the 2026 coverage year.
How Community Access Network Can Help
Remember, regardless of these potential changes, Community Access Network is here for you:
- We provide quality healthcare to everyone, with or without insurance
- Our sliding fee scale makes care affordable based on your income
- We’re open 5 days a week with extended hours to fit your schedule
- Our team can help you navigate insurance questions and enrollment
What You Can Do Now
- Stay informed about final rule changes (we’ll keep you updated)
- Mark your calendar for the next Open Enrollment Period
- Keep your income information current with the Marketplace
- File your taxes if you receive premium subsidies
- Contact us if you have questions about how to maintain your healthcare coverage
As your community healthcare provider, we’re committed to ensuring you continue to receive the care you need regardless of policy changes. We’ll help you navigate any new requirements so you can focus on what matters most—your health.
If you have questions or concerns about your healthcare coverage, please don’t hesitate to reach out to our team at 434-818-7880. We’re your neighbors, friends, and community members, and we’re here for you.
Our community. Our care.