Beyond the Headline: CMS Opens ACA Marketplace to Non-Network Plans
CMS just opened the ACA marketplace to non-network, reference-based pricing style plans — effective plan year 2028. For RBP-experienced TPAs and GAs, this is a convergence moment. Here's what the 2027 NBPP final rule actually does and why it matters for ICHRA.
On May 15, 2026, CMS published the final 2027 Notice of Benefit and Payment Parameters. Buried among enrollment integrity provisions and projected marketplace headcount reductions is a provision that could have huge implications for the ICHRA market.
Effective beginning in plan year 2028, CMS is allowing issuers offering non-network plans to receive certification to be offered as a Qualified Health Plan (QHP) through the federally-facilitated exchanges.
For anyone operating in the reference-based pricing space, or advising employers who are, read that again.
What the Rule Actually Does
Since the ACA's earliest years, QHP certification on the exchanges has required plans to maintain a contracted provider network and satisfy geographic network adequacy standards. That requirement has been the structural wall separating the RBP and direct contracting world from the individual market.
Unlike network-based plans, non-network plans do not rely on a contracted set of providers with whom the plans directly negotiate payment rates. Instead, these plans set specific benefit amounts for covered services and communicate those benefit amounts to enrollees. That is a description of reference-based pricing. CMS just finalized a pathway for it to live on the exchange.
The certification requirements aren't trivial. Non-network plans must demonstrate sufficient access to a range of providers that accept the non-network plan's benefit amount as payment in full, including essential community providers and behavioral health providers. These are real bars to clear, but clearable for organizations that have been running RBP programs in the group market for years.
Why This Matters Specifically for ICHRA
ICHRA's power as a benefits vehicle is directly proportional to the quality and breadth of individual market plan options available to employees. Until now, plan quality and availability on the individual marketplace has been good, not great.
Non-network QHPs certified on the exchange represent a structurally different option: plans built around a reimbursement methodology rather than a contracted network, potentially offering lower premiums in markets where traditional network construction is expensive.
The Convergence Opportunity for RBP-Experienced Operators
An organization with existing RBP capabilities — provider outreach infrastructure, reimbursement methodology, balance billing advocacy, member navigation — is materially better positioned to support or even sponsor a non-network QHP than an organization building from scratch. The certification requirements CMS has outlined map almost directly onto operational capabilities that experienced RBP operators already have.
Combined with ICHRA as the funding mechanism, the picture that emerges is as follows: an employer sets a defined contribution, employees shop an exchange that now includes lower-cost non-network options, and the TPA or GA supporting the program has infrastructure on both sides of that equation. That is a genuinely differentiated market position.
What to Watch for Now
PY 2028 effective date. The non-network QHP provision was pushed back one year from the proposed rule. That means open enrollment in fall 2027. Organizations serious about this need to be in motion now.
State variation will matter. States may elect to conduct their own provider access reviews. The landscape will not be uniform across markets from day one.
Balance Billing. Non-network plan design has always carried balance billing risk. How issuers handle this operationally will be a meaningful differentiator in consumer outcomes and regulatory scrutiny. Better transparency and pricing tools are a must.
The Bottom Line
CMS just structurally altered what the ACA individual market can look like starting in 2028. For ICHRA, it expands the menu of options employees will have access to. For TPAs and GAs with RBP capabilities, it creates a convergence opportunity that didn't exist before. For everyone in this space, it's worth understanding now — before the certification window opens and the first movers have already made their moves.
Kyndly provides an enablement layer for TPAs and GAs operating ICHRA programs — the operational infrastructure to run defined contribution health benefits at scale.