HHS Asks Public What Counts as Essential Health Benefits
Published Date: 6/15/2026
Proposed Rule
Summary
CMS wants your thoughts on the Essential Health Benefits (EHB) rules that decide what health care must be covered by insurance plans. This review affects people buying health insurance and employers offering plans, aiming to make sure benefits match typical employer plans and keep costs fair. Comments are open until July 15, 2026, and could lead to changes that impact what’s covered and how much you pay.
Analyzed Economic Effects
6 provisions identified: 2 benefits, 0 costs, 4 mixed.
Who Must Cover Essential Health Benefits
If you have a non-grandfathered individual or small-group health plan, your plan must cover the Essential Health Benefits (EHB) package as required by the Affordable Care Act; Section 2707 extends this requirement to such plans whether or not they are offered through an Exchange. This requirement applies to plans subject to EHB rules regardless of where you buy the plan.
Comprehensive Review Could Change Coverage and Costs
CMS is conducting a comprehensive review of the Essential Health Benefits (EHB) framework and the typical employer plan standard and is seeking public comment through July 15, 2026. The information CMS gathers could lead to future regulatory changes that affect what is covered as EHB and how much consumers and employers pay.
The Ten Essential Health Benefit Categories
Essential Health Benefits (EHB) must include at least these ten categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services (including behavioral health treatment); prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care. These categories define the minimum areas that applicable plans must cover.
Pause on State EHB Application Reviews
CMS has paused review of State applications to modify their EHB-benchmark plans pursuant to 45 CFR 156.111 for plan years beginning on or after January 1, 2027. This pause means State-requested benchmark updates for PYs starting January 1, 2027 are not being processed while CMS conducts its comprehensive review.
2025 Rule Changed State Update Options Starting PY2026
The 2025 Notice of Benefit and Payment Parameters revised 45 CFR 156.111 so that, beginning in plan year 2026, States can no longer adopt another State's EHB-benchmark plan in whole or replace individual EHB categories as the first two specific options for updating benchmarks. The typicality standard was also amended and the generosity standard was removed.
State Variation Persists; 12 States Updated Benchmarks
Since the 2019 Payment Notice established an application process, 12 States have updated their EHB-benchmark plans while the remaining States generally continue to use the EHB benchmarks that became applicable in plan year 2017. This means coverage scope and premiums can vary by State based on each State's benchmark.
Your PRIA Score
Personalized for You
How does this regulation affect your finances?
Sign up for a PRIA Policy Scan to see your personalized alignment score for this federal register document and every other regulation we track. We analyze your financial profile against policy provisions to show you exactly what matters to your wallet.
Key Dates
Department and Agencies
Related Federal Register Documents
2026-11530 — Employment and Training Services for Noncustodial Parents in the Child Support Program; Rescission
The government plans to cancel a recent rule that let child support agencies offer job training to noncustodial parents using federal funds. This change affects agencies and parents involved in the child support program and could shift how support services are funded and delivered. Comments on this proposal are open until August 10, 2026, so folks have time to weigh in before it’s final.
2026-11140 — Federal Independent Dispute Resolution Operations
Starting soon, health plans and insurers must share clearer info when they pay or deny surprise medical bills. They’ll use special codes to explain these decisions, especially when dealing with folks they don’t have contracts with. This helps patients and providers understand bills better and speeds up fixing disputes, with no extra costs for most people.
2026-10890 — Medicare Program; Alternative Payment Model Updates and the Increasing Organ Transplant Access (IOTA) Model
Starting July 1, 2026, Medicare is updating the Increasing Organ Transplant Access (IOTA) Model to help kidney transplant hospitals do even better at getting more people transplanted and improving care quality. These changes affect hospitals involved in kidney transplants and aim to make the process smoother and more effective, with new payment rules that reward success. This update is part of a 6-year plan running through 2031 to save more lives and boost patient experience.
2026-10292 — Medicaid Program; Medicaid Managed Care State Directed Payments and Medicaid Fee-for-Service Targeted Medicaid Practitioner Payments
This proposed rule changes how states can pay Medicaid managed care plans and certain doctors to make sure payments are fair, efficient, and encourage enough providers to offer quality care. It affects states, Medicaid managed care organizations, and targeted Medicaid practitioners, aiming to keep payments balanced and services available. Comments on these changes are open until July 21, 2026, so stakeholders have time to weigh in before it’s finalized.
2026-10050 — Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program
Starting in 2027, health insurance plans on federal and state marketplaces will see new rules to make coverage fairer and easier to use. These changes affect insurance companies, agents, and people buying plans, including new fees, penalties, and better protections for those with hardships. Expect updates on plan quality, dental coverage limits, and longer-term catastrophic plans, all aiming to keep your health coverage solid and affordable.
2026-09382 — Restoring Flexibility in the Child Care and Development Fund (CCDF)
Starting July 13, 2026, states and territories get more freedom in running the Child Care and Development Fund (CCDF). This means they no longer have to limit family co-pays to 7% of income or follow strict rules on paying child care providers. These changes cut red tape and could save money, making it easier to support families and child care programs.
Previous / Next Documents
Previous: 2026-11971 — Energy Conservation Program: Energy Conservation Standards for Distribution Transformers
The Department of Energy is checking how new energy-saving rules for distribution transformers, set to start in 2029, might affect U.S. factories and the supply of important materials. They want to make sure these rules don’t cause unfair costs or delays, especially since transformers are key for national security. If you have ideas or info, you can share them by July 15, 2026.
Next: 2026-12006 — Whistleblower Award Determination
The Commodity Futures Trading Commission is updating its whistleblower award rules to make the process faster, clearer, and fairer for people who report violations. These changes, inspired by similar SEC rules, aim to boost whistleblower confidence and improve how claims are handled. Comments on the proposal are open until July 15, 2026, so now’s the time to weigh in!