14. Department of Health and Human Services · Minor
Permit shared savings and reference pricing plan options
Printed page 469 14. Department of Health and Human Services
“Facilitate the development of shared savings and reference pricing plan options. … CMS should ensure that shared savings and reference pricing models that reward consumers are permitted.”
What has happened
- Partially done
CMS's 2027 Payment Notice finalizes standards allowing non-network plans — plans built on a reference-based payment amount rather than a contracted network — to be certified as qualified health plans on the Federally Facilitated Exchanges from plan year 2027, setting out how such a plan must set data-driven benefit amounts and disclose them. CMS states in the preamble that "encouraging innovation in plan design is the goal in which this proposal is rooted", and restates the existing position that treating providers who accept the reference amount as the only in-network providers does not violate the annual cost-sharing limit. Reference pricing is now permitted on the exchanges; the shared savings half of the ask — rewarding consumers who choose lower-cost care — has no corresponding action.
Research log
What was searched, and what didn’t count as evidence
Research notes
- The relevant passages were read at https://www.govinfo.gov/content/pkg/FR-2026-05-20/html/2026-10050.htm, sections on non-network plan QHP certification and on maximum out-of-pocket treatment of reference-based pricing.
- Searched: Federal Register “reference-based pricing” since 2025-01-20 → 4 documents (this rule, its proposal, the Transparency in Coverage proposal, and a DOJ antitrust filing); “shared savings plan” → 0. The 22 hits for “shared savings” are all the Medicare Shared Savings Program, a different object (see #1269).
- Why partial: an ask with two objects, one of them delivered, is partial — one object delivered, one not.
- Action
- expand
- Object
- shared savings and reference pricing plan options
- ID
- 1290