BENEFITS DIGEST

Sydney Halleman reports on the CMS proposal requiring marketplace enrollees to verify their eligibility before premium tax credits and income-based cost-sharing help are paid, with annual confirmation starting with 2028 coverage and a verification window opening August 1, 2027. The agency’s own estimate of 332,500 fewer enrollees a year is a projection, not an observed result. A caution for careful readers is that the article blurs the enhanced premium credits now expiring with the underlying assistance the proposal addresses, which are two different programs on two different tracks.

Acrisure’s first-quarter 2027 calendar gives benefits teams the January-through-March picture. For applicable employers, it lists February 1 for W-2 health-coverage cost reporting and March 1 for the calendar-year Medicare Part D disclosure. It lists March 2 for furnishing ACA statements, subject to permitted alternatives, March 1 for eligible paper filers and March 31 for electronic filing. The calendar covers federal filings and notices with calendar-year qualifications and isn’t exhaustive.

This is the sponsor-side read of the premium tax credit [proposed regulations](https://www.federalregister.gov/d/2026-21056). The firm separates the schedules, with repayment changes effective for 2026, immigration-related eligibility changes for 2027, and verification changes for 2028, and notes that employer reporting on Forms 1095-B and 1095-C continues unchanged. Effects on marketplace enrollment and employer penalty exposure are possibilities the firm flags rather than assured outcomes. Comments are due November 30 with a hearing set for December 8.

Employers that rely on brokers to help workers obtain individual-market coverage have a stake in the federal freeze on registering and training new Marketplace agents and brokers, which runs through February 1, 2027 and overlaps the November 1 to January 15 enrollment window. The National Association of Benefits and Insurance Professionals is suing HHS over the freeze, which Healthcare Dive reports affects roughly 19,000 agents. The association’s [complaint](https://digest.theinnerfirm.com/docs/nabip-v-kennedy-complaint-2026-10-15.pdf) says HHS acted without adequate authority or required procedure, while the government points to enrollment misconduct. No court has ruled on the freeze’s lawfulness.

Fisher Phillips assembles an open-enrollment checklist that runs from eligibility and the ACA offer requirement through prospective section 125 elections, required disclosures, and enrollment access for employees on FMLA leave or COBRA. The guide collects the 2027 dollar limits announced so far, including HSA figures the article sources to Rev. Proc. 2026-24, and flags the figures still awaiting announcement. The guide’s process reminder is that plan terms, cafeteria-plan rules and enrollment communications have to agree, and that the carrier does not handle compliance by default.

Holland & Knight expects the next wave of employer shared-responsibility notices, for tax year 2024, in late 2026, a timing estimate drawn from the firm’s experience rather than any IRS commitment. Letter 226-J proposes an assessment that often reflects reporting errors on Forms 1094-C and 1095-C rather than a real failure to offer coverage, so the response is reconciliation work against original returns, payroll and coverage records. The deadline that matters is the one printed on the letter, and more time can be requested.

Treasury and the IRS propose regulations implementing changes to Marketplace premium tax credits on several schedules. The 2026 changes include removal of limits on repayment of excess advance credits. Additional eligibility restrictions apply in 2027, while expanded verification requirements begin in 2028. The [proposal as published](https://www.federalregister.gov/documents/2026/10/15/2026-21056/premium-tax-credit) distinguishes the law’s effective dates from the proposed regulations’ applicability provisions. It doesn’t impose new employer Forms 1095-B or 1095-C reporting requirements, and some underlying statutory changes already apply even though these implementing regulations aren’t final. Treasury and the IRS summarize the package in an accompanying [news release](https://www.irs.gov/newsroom/treasury-and-irs-move-to-protect-health-care-benefits-for-eligible-americans). Comments are due November 30, 2026.

KFF maps this year’s marketplace contraction district by district. The number of people with active marketplace coverage fell from 21.8 million to 19.2 million by February, a 12 percent drop and the first decline in seven years, after the enhanced premium tax credits expired, and one in ten of last year’s enrollees reports becoming uninsured. For those who stayed, average premium payments rose 58 percent and deductibles about $1,000. The political geography is the story. Republican-held districts account for 55 percent of current enrollees but 67 percent of the decline, and the districts with the heaviest marketplace reliance sit in Florida, Texas and Georgia, where enrollment approaches 30 percent of the population in several South Florida seats. For employers in those markets, the individual market’s churn is the backdrop for this fall’s dependent and part-timer coverage questions.

Employers with six or more Massachusetts employees must file the annual Health Insurance Responsibility Disclosure form through MassTaxConnect, with the window opening November 15 and the filing due December 15. The six-employee test looks at DUA wage reports over the trailing twelve months, so companies with even a small Massachusetts footprint can be covered. The form collects plan-level information the state uses to run its MassHealth Premium Assistance program, which can move eligible employees into subsidized coverage that coordinates with the employer plan. Aon confirms the requirements are unchanged for 2026. A payroll vendor can transmit the filing, but the employer owns its accuracy, so calendar the window and confirm who is actually submitting.

KFF’s updated tracker counts 11 carriers announcing full or partial exits from the ACA marketplaces for 2027 against six entering new states. Cigna is the headline departure, leaving the individual market in all 11 of its states after reporting more than 350,000 on-exchange members in the first quarter. KFF ties the retrenchment to the expiration of the enhanced premium tax credits at the end of 2025, which already cut sign-ups by more than a million between the 2025 and 2026 open enrollments, shrinking the market and likely worsening the risk pool as healthier enrollees drop first. Employers feel this indirectly but concretely. Fewer individual-market options can make employer-funded individual coverage less attractive, narrow the alternatives for departing employees weighing COBRA, and raise the stakes of the subsidy fight Congress has not resolved.

After the enhanced premium tax credits expired, net premium payments in the Affordable Care Act marketplaces rose 58 percent on average, and 114 percent for those staying in the same plan. Enrollment among people who paid their premiums fell from 21.8 million to 19.2 million, the first drop in seven years, and insurers are seeking a median 15 percent increase for 2027 while citing a deteriorating risk pool. CBO puts the combined uninsured increase from the reconciliation law and the credit expiry above 14 million by 2034. The increases matter for workers comparing COBRA with individual coverage and for part-time employees who aren’t eligible for employer coverage.

Treasury checks of $500 began going out Wednesday to more than 950,000 people in the 30 states that use the federal marketplace, money the administration describes as a refund of excess healthcare.gov user fees collected from insurers. Recipients are mostly enrollees who earn above 400 percent of the federal poverty level and lost premium help when the enhanced subsidies expired at the end of last year; people still receiving subsidies and residents of state-run exchanges are not eligible. The administration says the checks draw on a $500 million fund of user fees that ordinarily pays for call centers, technology, and enrollment outreach. No rule or formal notice accompanies the program so far; the account comes from an administration official and a letter from the President included with the checks. Employers fielding questions from part-time or former employees on marketplace coverage may want to know the checks are real.

Federal oversight of the ACA marketplaces just escalated sharply. In late August, CMS canceled about 315,000 policies covering more than 760,000 people, roughly 4 percent of marketplace enrollment, after concluding the enrollments were unauthorized, and it plans to investigate 440,000 more. An interim final rule published September 23 then froze new agent and broker registrations for the federally facilitated marketplaces for the 2027 plan year, a moratorium expected to run to February 1, 2027. CMS expects to recover about $2.2 billion in advance premium tax credits, and enrollees who did not answer a 30-day verification request lost coverage, which Morgan Lewis notes has stakeholders asking whether legitimate enrollments were swept in. Employers are not directly regulated here, but a tightened individual market changes the fallback for COBRA-eligible workers, part-timers, and early retirees, with open enrollment starting November 1.

Employers that charge tobacco users more for health coverage have received some enforcement relief from federal agencies. The [August FAQs](https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/faqs/aca-part-74) from the Labor Department, HHS, and Treasury say the agencies will not enforce the requirement to pay the full wellness reward retroactively to workers who quit tobacco midyear, and they narrow which materials must explain the reasonable alternative, another way to earn the reward, such as completing a tobacco-cessation program. But the agencies' decision doesn't prevent employee lawsuits, as Marsh's alert explains. More than 75 lawsuits over tobacco surcharges are pending, appeals are before five federal appeals courts, and plaintiffs are also arguing that the underlying wellness rules are invalid. Programs should keep the reasonable alternative real: offer it, honor it, and disclose it. The FAQs changed the government's posture, not the law private plaintiffs sue under.

CMS has paused new agent and broker registrations for the federal ACA exchanges through February 1 and canceled coverage for more than 760,000 people it says were enrolled without authorization. New brokers make up 11 percent of the field but drew 30 percent of compliance terminations for the 2026 plan year, per the agency, which has sent termination notices to more than 200 agents and brokers since January. Existing agents must re-verify their identities, and a new HHS anti-fraud group will meet regularly. A trade group for insurance professionals calls the blanket freeze "a blunt and inappropriate response" that could thin broker capacity during open enrollment. Employers that reimburse workers for individual health insurance through an ICHRA should consider whether these changes affect the brokers their employees use. Workers who buy marketplace coverage should also check their enrollment status before open enrollment.

CMS has paused registration for federal Marketplace agents and brokers who don't have a 2026 Exchange agreement. The pause took effect September 22 and is scheduled to run until February 1, 2027. Brokers who already hold 2026 agreements aren't affected. CMS cites more than 624,000 complaints about unauthorized enrollments or plan switching from 2023 through 2025. In a separate action, the agency canceled about 315,000 policies covering more than 760,000 people on August 31. Newly registered brokers accounted for about 11 percent of brokers with active enrollments but received about 30 percent of the 569 termination notices issued in July and August. HHS skipped advance notice and comment, saying advance warning could prompt a rush to register. Comments on the interim final rule are due November 21.

Written for construction employers, useful to any sponsor. A significant share of health plan cost is driven by who else is covered. Dependent-eligibility audits catch ineligible dependents whose claims an insurer or stop-loss carrier may refuse. Spousal surcharges and carve-outs raise consistency, Medicare and TRICARE questions. Opt-out payments must be structured through the cafeteria plan and counted in ACA affordability math. Each approach asks employers to weigh potential savings against administration, documentation and compliance obligations, and Saul Ewing's four-question checklist (clear eligibility definitions, administrative feasibility, interaction with other requirements, workforce impact) is the useful takeaway.

Segal's reference table adds the 2026 employer shared responsibility penalty amounts, the 2026 affordability percentage, and the federal poverty line safe harbor for plan years beginning January 1, 2026, a practical one-stop update for ACA compliance planning.

While the legislation's future is still unclear, there are many important things for leaders to know.

New NIRS survey shows deepening concerns about retirement viability in current economy, plus a distrust of AI financial advice and crypto investments.

On August 10, President Trump signed an executive order directing HHS to sort childhood vaccines into three tiers of recommendation within 90 days. Groom's read for plan sponsors: the order doesn't itself revise the CDC's ACIP-based immunization schedule, so the ACA's requirement that non-grandfathered group health plans cover ACIP-recommended immunizations without cost-sharing is unchanged for now. HHS's request for comment on the new framework runs through September 20.

HHS filed a request for information asking how federal vaccine recommendations should be categorized and what role shared clinical decision-making should play. We are tracking it because non-grandfathered group health plans must cover recommended immunizations without cost sharing under the ACA preventive services mandate, and the recommendation categories are the input to that requirement. This is an RFI, not a rule, so nothing changes for plan sponsors now; the question is whether it ripens into rulemaking that touches first-dollar coverage.

A Massachusetts federal judge vacated the marketplace rule's restriction on coverage of gender-affirming care while upholding several other ACA rollback provisions. A marketplace-side ruling, but one carriers and multi-state plans will be tracking.

Employers name high drug prices, high-cost claims, and hospital prices as their biggest affordability threats, and most say healthcare inflation is now eating directly into salary budgets. The compensation-side echo of the 10 percent trend number IFEBP put up last week.

are making them hesitant to move forward, according to a survey.

Revenue Procedure 2026-26 provides the 2027 indexing adjustments for the ACA premium tax credit applicable percentage table and sets the required contribution percentage at 10.22 percent, up from 9.96 percent for 2026. That figure drives the employer affordability safe harbors, so sponsors should have it in hand before setting 2027 employee contributions.

The American 401(k) is often celebrated as one of the greatest financial innovations of the past half century. Millions of workers have accumulated retirement savings through payroll deductions, employer matching contributions, and decades of economic growth.

Most analyses of the 401(k) industry rank providers according to assets under management, number of plans, or participants. While useful, these rankings fail to explain why some providers consistently appear in ERISA excessive-fee litigation while others rarely do.

ACA Marketplace insurers are proposing a median premium increase of 14% for 2027— indicating a likely second consecutive year of double-digit increases, according to a new analysis of preliminary rate filings in 16 states and DC.

In Supreme Linen Services, Inc. v. U.S., 2026 WL 1220078 (S.D. Fla. 2026), an employer sued the federal government after the Internal Revenue Service (IRS) assessed an employer shared responsibility penalty against the company.

The expiration of the ACA’s enhanced premium tax credits at the start of 2026, combined with rising insurer premiums, put a spotlight on health care affordability that extends beyond Marketplace enrollees.