A June 25, 2025, final rule had made adjustments to several Affordable Care Act (ACA) provisions, primarily focusing on the public health insurance Exchange Marketplace to adjust things like special enrollments, tax credits, and open enrollment periods. On Monday, August 25, 2025, a federal court in Maryland issued a stay on portions of that rule, but this should not directly impact employers or their group health plans. The federal government has provided a list of the changes that will not take effect as a result of this ruling, and none of them directly impact employers.
Applies To: No impact to employers or their group health plans, and no action needed.
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One challenge was the provision that adjusted the methodology for calculating the premium adjustment percentage, which increased the out-of-pocket limit (OOP) for non-grandfathered plans renewing next year to $10,600 per person and $21,200 per family. The court determined that the government had followed proper procedures to reasonably determine the adjustment was necessary and appropriate, so the revised OOP for non-grandfathered plans renewing in 2026 will remain at the revised limits.
Another challenge was the provision that alters de minimis tolerances for various metal levels within Exchange plans. Typically, plans must have an actuarial value within ±2 percentage points of each metal level to qualify for that metal level (silver is 70% ±2, gold is 80% ±2, platinum is 90% ±2), with bronze at 60% +5% or -2%. Those tolerances were proposed to adjust to +2/-4 (and +5/-4 for bronze). The court determined regulators “provided an insufficient and conclusory rationale for altering the de minimis variation,” so the change in tolerances is blocked. In an employer context, this simply means an applicable large employer (ALE) sponsoring an individual coverage health reimbursement arrangement (ICHRA), which must base affordability on the lowest-cost silver plan for the respective ZIP code, will continue to likely be a plan providing close to a 68% actuarial value rather than a plan as low as 66%.
Other provisions challenged, such as changes to special enrollment periods or qualifications for tax credits, are not directly impactful to employers or group health plans outside of affecting which full-time employees may or may not qualify for tax credits that could potentially trigger penalties to ALEs. So, there is no direct impact on employers and no action employers need to take.