New CMS Rule: $5 Monthly Fee for Some $0 Plans in 2026

In June 2025, the Centers for Medicare & Medicaid Services (CMS) approved a new rule aimed at protecting the integrity of the health insurance marketplace, preventing fraud, waste, and abuse.

One of the most notable measures affects members of a Federal Marketplace (FFM) who have a $0 monthly premium health plan and are automatically renewed (also called “passive renewal”) for the 2026 plan year.

What’s changing?

If the member does not verify their eligibility for the APTC (Advance Premium Tax Credit) before the end of the Open Enrollment Period (OEP), they will be charged a $5 monthly fee until eligibility is confirmed.

Once CMS confirms eligibility, the subsidy will be fully reinstated and the premium will return to $0 from that point forward.

Who does this rule apply to?

• Members in an FFM with $0 plans that renew automatically for 2026.

• People who do not update or confirm their eligibility information (income, citizenship, or immigration status) during the OEP.

Does not apply to:

• Members in State-Based Marketplaces (SBEs).

• Plans with a premium higher than $0.

Example

Mark, a Florida resident, has a $0 plan in 2025 and does not update his information for 2026.

• January to March: pays $5 per month.

• April: after sending the required documentation, his plan goes back to $0.

• If he does not pay the fee for three months, he may lose coverage.

Tips to avoid the $5 fee:

✅ Update your information on healthcare.gov during the OEP.

✅ Have the required documentation ready: income, proof of citizenship, or immigration status.

✅ Renew your plan actively, not passively.

✅ Consult with an insurance agent or advisor to confirm your eligibility on time.

If you need help reviewing your plan or confirming your eligibility,

MDR Tax Filing can guide you step-by-step.

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www.mdrtaxfiling.com