Marketplace insurance tax credits would use income-based rules through 2027

Tax credits that help pay marketplace insurance premiums would use an income-based formula. The income ceiling would be 935% of the federal poverty line, a measure of household income. Households would need to qualify for the tax credit. The formula would use income percentages ranging from 0% to 9.35%. These rules would apply to tax years beginning on or after January 1, 2026, and before January 1, 2028.

Insurance agents and brokers would face fines and possible prison time for specified false enrollment information. These penalties would cover agents and brokers providing specified information for marketplace insurance applications. Incorrect information caused by carelessness or disregard of federal rules would carry civil fines of $10,000 to $50,000 per affected applicant. Knowingly false or fraudulent information would carry civil fines of up to $200,000 per affected applicant. Knowingly and willfully providing false or fraudulent information could bring a criminal fine, up to 10 years in prison, or both.

Federal health officials would require proof that customers agreed to broker-assisted enrollments and coverage changes. The checks would cover submissions on federally run marketplaces for which an agent or broker could earn a commission. Agents and brokers would provide evidence of customer consent. Commissions would be paid only after the customer resolves application information problems. Rule violations by an agent, broker, or health plan could not cause a person to lose coverage without that person's consent. The checks would start with plan years chosen by federal health officials, no later than January 1, 2029.

Federal health officials would set conduct rules and oversee agents and brokers through audits. States would use the conduct rules to decide who may help people enroll in marketplace plans. Agents and brokers would have to act in customers' best interests. Covered agents, brokers, and marketing firms could not use confusing or misleading practices. Audits would consider customer complaints, signs of fraud, and other factors chosen by federal health officials. Conduct rules and audit oversight would start with plan years chosen by federal health officials, no later than January 1, 2029.

Federal health officials would set the marketplace enrollment window for 2026 coverage. The dates would apply to the annual enrollment period for 2026 marketplace health insurance. The enrollment period would begin November 1, 2025, and end May 15, 2026.