You may have heard a version of this: starting in 2027, the Marketplace will sell plans with no provider network at all. No in-network list, no out-of-network penalty — just a plan that pays a set dollar amount toward each service and leaves you to find someone who will take it. That would be a large change. It is also not something you will see when the 2027 Open Enrollment window opens on November 1, 2026.
Both halves matter, and most summaries get one of them wrong. The rule is real and it was finalized — then a federal court stopped it, along with the expansion of catastrophic plan eligibility that traveled with it. The federal regulations website still displays some of the paused language as though it were live, which is why people keep repeating rules that are not in force.
Below: what a non-network plan actually is, what happens to your bill when nobody has negotiated a price for you, who can buy a catastrophic plan in Texas today, and what changes for Harris County in 2027.
The 2027 ceiling on what a Marketplace plan can make you pay in deductibles, copays and coinsurance for essential health benefits — $24,000 for a family. Balance-billed amounts do not count toward it.
CMS payment parameters guidance, January 29, 2026- Non-network plans were never coming to Texas for 2027. The rule let state-run Marketplaces certify them from plan year 2027, but set the federally facilitated Marketplace — which Texas uses — at plan year 2028.
- And that 2028 start is now paused. On July 16, 2026 a federal court stayed the non-network rule at 45 CFR 156.236 and the catastrophic eligibility expansion, while the case proceeds.
- A non-network plan pays a fixed benefit amount, not a negotiated rate. Anything a provider charges above it is a balance bill — and balance bills do not count toward your out-of-pocket maximum.
- Surprise-billing protections work differently without a network. No Surprises Act protections for emergency care and air ambulance still apply; those for care at an in-network facility cannot, because there is none.
- Catastrophic eligibility in Texas is unchanged: under 30, or certified for an affordability or hardship exemption. Only 89 Harris County residents chose a catastrophic plan for 2026.
- What is genuinely new for 2027: the out-of-pocket ceiling rises to $12,000 self-only and $24,000 family, and Open Enrollment runs November 1, 2026 through January 15, 2027.
What this article covers
- What actually happened between February and July 2026
- What a “non-network” plan is, in plain terms
- Non-network versus HMO, EPO and PPO
- Cost sharing and balance billing when there is no network
- Catastrophic plans: who qualifies in Texas today
- What is actually changing for Houston in 2027
- The Harris County picture
- How to weigh one of these against a standard Silver plan
- Frequently asked questions
What actually happened between February and July 2026
Four dates explain the confusion. On February 11, 2026, HHS proposed its rule for the 2027 plan year — the annual regulation the industry calls the Payment Notice — including a reversal of the standing prohibition on certifying plans that have no provider network. On May 20, 2026, the final rule was published at 91 FR 29526. It kept the policy but changed the timing: state-run Marketplaces could allow these plans from plan year 2027, while the federally facilitated Marketplace would not certify them until plan year 2028. Texas has no state-run exchange, so even in the rule as written, no Houston shopper was going to see a non-network plan for 2027.
Then, on July 16, 2026, the U.S. District Court for the District of Maryland, in City of Columbus v. Kennedy, No. 1:26-cv-02215, stayed a list of provisions in that final rule while the litigation continues. A CMS statement on July 31, 2026 identified what was stopped: the non-network policy at 45 CFR 156.236, the catastrophic eligibility expansion, the bronze and catastrophic out-of-pocket changes, and the removal of standardized plan options. That is the second case; an earlier one vacated provisions of the 2025 Marketplace Integrity and Affordability rule on June 12, 2026 and is now on appeal to the Fourth Circuit. One consequence is the enrollment window itself: CMS confirmed on July 27, 2026 that Open Enrollment begins November 1, 2026 and ends January 15, 2027.
What is stayed, and what survived
The distinction matters, because parts of the rule are fully in effect.
| Provision in the 2027 Payment Notice | What it would do | Status as of late August 2026 |
|---|---|---|
| Non-network plans as QHPs (45 CFR 156.236) | Allow plans with no network on the federal Marketplace from 2028 | Stayed July 16, 2026 |
| Catastrophic eligibility expansion (45 CFR 155.605(d)(1)(iv)) | Add a hardship exemption tied to projected income | Stayed, with the 2025 guidance |
| Bronze out-of-pocket expansion (45 CFR 156.136) | Let bronze plans exceed the ceiling by up to 130 percent | Stayed |
| Catastrophic cost sharing (45 CFR 156.155(a)(3)) | Raise the catastrophic deductible to 130 percent of the limit | Stayed |
| End of standardized plan options | Drop standardized designs and the non-standardized cap | Stayed |
| Multi-year catastrophic terms (45 CFR 156.155(a)(6)) | Terms up to 10 consecutive plan years, from 2027 | Not on the stay list |
| 2027 Marketplace user fee | 1.9 percent of monthly premiums | In effect |
| 2027 cost-sharing parameters | $12,000 self-only, $24,000 family maximum | In effect |
If you want the underlying documents rather than a summary, the final rule at 91 FR 29526 and the CMS statement of July 31, 2026 are the two that settle most arguments.
What a “non-network” plan is, in plain terms
Every plan you have bought on the Marketplace works the same way behind the scenes. The insurer signs contracts with hospitals, clinics and physicians, and each sets a negotiated rate. Those contracted providers are the network. When you use one, the provider has already agreed to accept that rate as payment in full, and your share is whatever the plan says.
A non-network plan removes the contracts. In the words of the final rule, these plans “do not rely on a contracted set of providers that agree in advance to specific terms and negotiated payment rates.” Instead the plan publishes a benefit amount for each covered service — a dollar figure it will pay, often a percentage of a public benchmark such as Medicare rates, or what the rule calls “a reference-based pricing structure.” You take that number to any provider you like.
So the plan does not tell you where to go. It tells you how much it will pay. Whether that is enough is between you and the provider.
To keep that from becoming a plan that pays a token amount and calls it coverage, 45 CFR 156.236(a) requires a non-network plan to “ensure access to a range of providers that accept the non-network plan’s benefit amount as payment in full,” specifically including essential community providers — the safety-net clinics serving low-income, medically underserved communities — and mental health and substance use disorder providers. A plan does not satisfy this, the rule adds, “by simply providing some benefit amount for covered services rendered by any provider.”
The stayed rule would also have required an issuer to file nine categories of information before certification, among them the share of area providers accepting its benefit amounts, how it sets and publishes them, how it explains potential balance billing, whether it offers an exceptions process for enrollees who cannot find a willing provider, and how it delivers real-time cost estimates before care.
Notice what that list implies. The consumer protections built for this plan type are disclosure requirements and an exceptions process — not an assurance that a provider near you will take the money.
Non-network versus HMO, EPO and PPO
Houston shoppers know three shapes of plan. Here is where a fourth would sit.
| Feature | HMO | EPO | PPO | Non-network |
|---|---|---|---|---|
| Who negotiates the price | The insurer | The insurer | The insurer | You, at the point of care |
| Provider list | Yes, narrow | Yes | Yes, plus out-of-network tier | None; the plan publishes dollar amounts |
| Out-of-network coverage | Emergencies only | Emergencies only | Covered at a higher cost share | Does not apply |
| Referral to see a specialist | Usually required | Usually not | Not required | Not applicable |
| Provider pre-agreed to accept payment in full | Yes, in-network | Yes, in-network | Yes, in-network | No agreement exists |
| Risk of a balance bill | Low in-network | Low in-network | Low in-network, real out-of-network | Present at every visit unless the provider accepts the amount |
| Available on the Texas Marketplace for 2027 | Yes | Yes | Yes, where offered | No |
If you compare Houston plans by asking whether Memorial Hermann, Houston Methodist or your child’s pediatrician is in the network, a non-network plan replaces that with a different question: will this practice accept this dollar amount, for this procedure, on the day I need it. You must ask it again for every provider and service, and the answer can change. Our walkthroughs of ACA Marketplace plans and how health insurance works cover how the existing network types behave across the metro.
Cost sharing and balance billing when there is no network
This is the part that decides whether one of these plans could work for your household.
The out-of-pocket maximum still exists — but it does not cover everything
A non-network plan certified as a qualified health plan is still a qualified health plan. It must cover the ten categories of essential health benefits and is still bound by the annual limitation on cost sharing, which for 2027 is $12,000 self-only and $24,000 otherwise, up from $10,600 and $21,200 in 2026.
Here is the catch, written into the definition of cost sharing at 45 CFR 156.20. Cost sharing means deductibles, coinsurance, copayments and similar charges, but it excludes premiums, spending on non-covered services, and “balance billing amounts for non-network providers that are not prohibited by the No Surprises Act.”
Read that again. If the plan’s benefit amount for a procedure is $4,000 and the surgeon bills $9,000, the $5,000 gap is a balance bill. It is not cost sharing, and it does not count toward your $12,000 ceiling. You could hit the out-of-pocket maximum and still owe balance bills on top of it.
What the No Surprises Act does and does not do here
In the 2027 final rule, CMS spelled out how the No Surprises Act applies to a plan with no network. The answer splits cleanly in two.
Still protected. The federal Departments have stated that the surprise billing provisions apply to plans without a network with respect to emergency services and air ambulance services. Those protections, CMS wrote, “are not dependent on whether the group health plan or group or individual health insurance coverage has a network of providers.”
Not protected. The other major piece — the one that shields you when an out-of-network anesthesiologist, radiologist or pathologist treats you during a visit to an in-network facility — depends on there being a participating facility, meaning one with a contract. Those provisions, CMS wrote, “would never be triggered if a plan or coverage does not have a network of participating facilities.”
That gap has a name in ordinary life: the surgery you scheduled. You can negotiate with the surgeon. But as CMS agreed, a patient generally cannot negotiate with the anesthesiologist or pathologist, who are chosen during the procedure by clinical necessity. CMS responded by adding 45 CFR 156.236(b)(7), requiring the plan to have a strategy for helping enrollees navigate “episodes of care with multiple benefit amounts.” That is a communication requirement, not a cap on what the ancillary provider may bill.
| Situation | Standard network plan | Non-network plan |
|---|---|---|
| Emergency room visit, out-of-network hospital | Protected by the No Surprises Act | Protected by the No Surprises Act |
| Air ambulance transport | Protected | Protected |
| Out-of-network anesthesiologist during in-network surgery | Protected | Protection cannot be triggered — no participating facility exists |
| Planned surgery with a provider you chose | Cost share set by contract | You pay the gap between the benefit amount and the charge |
| Does a balance bill count toward the out-of-pocket maximum? | Not for non-network providers | No |
| Appeals and exceptions rights | Yes | Yes — all individual-market protections still apply |
One protection is worth naming: CMS confirmed that non-network plans “must provide all the same consumer protections that apply to individual and small group health insurance,” including appeals.
Catastrophic plans: who qualifies in Texas today
A catastrophic plan is a specific creature of the Affordable Care Act, defined at section 1302(e) and codified at 42 U.S.C. 18022(e). It covers the same essential health benefits as any Marketplace plan, plus at least three primary care visits and preventive services before the deductible, but pays nothing else until you have spent up to the annual limitation on cost sharing. For 2027 that means a deductible equal to the full $12,000 self-only ceiling.
The reason these plans are rare is that hardly anyone may buy one. Under 42 U.S.C. 18022(e)(2) and 45 CFR 155.305(h), the Marketplace may enroll you only if you meet the general eligibility rules and either have not turned 30 before the plan year begins, or hold a certification that you are exempt from the individual coverage requirement because coverage is unaffordable or because of a hardship. The affordability exemption turns on the required contribution percentage, which CMS set at 8.50 percent for 2027, up from 8.05 percent.
What the expansion would have done — and why it is not in effect
The 2027 Payment Notice added a hardship exemption at 45 CFR 155.605(d)(1)(iv) for an applicant whose projected household income does not qualify them as an applicable taxpayer for the premium tax credit, or for cost-sharing reductions. That reaches two groups at opposite ends of the range: households projecting income below 100 percent of the federal poverty level, and those above 250 percent. HHS had extended this by guidance on September 4, 2025, and the rule would have made it nationwide.
The July 16, 2026 order stayed the provision and that guidance. As of late August 2026 neither is operative, so catastrophic eligibility in Texas rests where it has for years: age, affordability exemption, or hardship exemption.
What is actually changing for Houston in 2027
Strip away the paused provisions and a real set of changes remains.
Three consequences follow. The ceiling moved a long way in one year — a self-only enrollee’s worst-case cost sharing rose $1,400, a family’s $2,800. If you are budgeting for a bad year, use the 2027 numbers.
Cost-sharing reductions remain the largest lever most Houston households have. An enrollee between 100 and 200 percent of poverty who chooses a Silver plan has an out-of-pocket ceiling of $4,000 rather than $12,000 — an $8,000 difference in a bad year. Those reductions attach only to Silver plans, so choosing Bronze for the smaller monthly premium discards them entirely.
And standardized plan options are still required for 2027, because the rule removing them is stayed, so the side-by-side designs that make comparison easier remain. Two smaller items: the federal Marketplace user fee is 1.9 percent of monthly premiums, and Open Enrollment runs November 1, 2026 through January 15, 2027.
The Harris County picture
Harris County is the largest Marketplace county in Texas. In the 2026 Open Enrollment Period, 731,300 people here selected a plan — 17.5 percent of the state’s 4,172,233. Of those, 681,933 (93.2 percent) took an advance premium tax credit, and the average premium ran $647 a month before the credit and $78 after. Two numbers tell you most of what you need to know about how these rule changes would land locally.
First: catastrophic plans are already a rounding error here. Eighty-nine Harris County residents selected one for 2026 — roughly one in every 8,200 enrollees. That is what a $12,000 deductible looks like in a county where the average premium after the tax credit is $78 a month. Widening eligibility, if the stay is lifted, would open a door that very few Houston households have a reason to walk through.
Second: most local enrollees sit in the income range where cost-sharing reductions are available — the protection worth guarding when an unfamiliar plan structure appears on the menu.
The wider context: in the 2024 American Community Survey, 1,038,207 Harris County residents — 20.8 percent of the civilian noninstitutionalized population — had no health insurance, against 16.7 percent statewide and 8.2 percent nationally. Any plan design that shifts more billing risk onto the patient meets a population already thinly covered.
| Harris County, 2026 coverage year | Figure |
|---|---|
| Marketplace plan selections | 731,300 |
| Enrollees receiving an advance premium tax credit | 681,933 (93.2%) |
| Enrollees receiving cost-sharing reductions | 225,823 (30.9%) |
| Enrollees with income 100-250% of poverty | 648,787 (88.7%) |
| Catastrophic plan selections | 89 |
| Average monthly premium, before / after the credit | $647 / $78 |
| Uninsured rate (2024 ACS) | 20.8% |
How to weigh one of these against a standard Silver plan
No Texas household faces this decision for 2027. But state-run Marketplaces may allow these plans as early as 2027, the federal rule points at 2028, and the litigation will resolve one way or the other. When the choice arrives, the comparison is not premium against premium. It is certainty against optionality.
Five questions that decide it
- What does the plan pay for the things you actually use? Not the brochure — the published benefit amounts for your medications, specialist visits, imaging, labs, and one realistic bad event.
- Will your practices accept that amount as payment in full? Ask the billing office by name and by procedure. A plan-level statistic about area providers will not tell you whether your cardiologist accepts it.
- What happens during an episode you cannot script? Surgery triggers anesthesiology, pathology and radiology charges you do not choose, and the No Surprises Act protection for that scenario does not apply without participating facilities.
- Do you qualify for cost-sharing reductions? Between 100 and 250 percent of poverty, a Silver plan carries a ceiling of $4,000 or $9,600 in 2027 rather than $12,000. Weigh any alternative against what you would give up.
- How much cash could you absorb in a bad year, counting bills that never touch the out-of-pocket maximum? In a network plan the ceiling is close to the real worst case; in a non-network plan it is a floor under one category of spending.
Get a straight read on your 2027 options before the window opens
Wise Insurance Agency is an independent, Texas-licensed agency serving Houston and Harris County. Bring your prescriptions, your doctors and your expected income, and we will check network status plan by plan, tell you whether cost-sharing reductions are on the table, and explain which of this year’s rule changes actually reach your household.
Talk to a licensed Houston agent 832-400-6538We have offices at both ends of the metro — north Houston and south Houston. If your household spans a Marketplace plan and a Medicare beneficiary, our Medicare page covers that side; small employers should start with employer health insurance plans. Reach us at 832-400-6538 or sara@wisehealthins.com.
Frequently asked questions
Will I see a health plan with no provider network when I shop for 2027 coverage in Houston?
What is a “benefit amount,” and how is it different from a negotiated rate?
If non-network plans are stopped, why does 45 CFR 156.236 still appear in the federal regulations?
Do balance bills count toward my out-of-pocket maximum?
Does the No Surprises Act protect me in a plan that has no network?
Who can buy a catastrophic plan in Texas for 2027?
What is the 2027 out-of-pocket maximum, and did the bronze plan limit change?
When is Open Enrollment for 2027 coverage in Texas?
Sources
- CMS, “HHS Notice of Benefit and Payment Parameters for 2027 Final Rule” (fact sheet), May 15, 2026. https://www.cms.gov/newsroom/fact-sheets/hhs-notice-benefit-payment-parameters-2027-final-rule
- HHS, “HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program,” final rule, 91 FR 29526, May 20, 2026. https://www.federalregister.gov/documents/2026/05/20/2026-10050/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2027-and
- HHS, proposed rule, 91 FR 6292, February 11, 2026. https://www.federalregister.gov/documents/2026/02/11/2026-02769/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2027-and
- CMS, “Statement Regarding the City of Columbus v. Kennedy, No. 1:26-cv-02215,” July 31, 2026. https://www.cms.gov/files/document/statement-re-city-columbus-073126.pdf
- CMS, “Updated Statement regarding the Failure to File and Reconcile requirement for Plan Years 2026-2027,” July 27, 2026. https://www.cms.gov/files/document/ftr-requirement-py26-27-statement.pdf
- CMS, “Impacts of City of Columbus v. Kennedy on Open Enrollment (OE) 2026,” September 19, 2025. https://www.cms.gov/files/document/columbus-kennedy-impacts.pdf
- CMS, “Premium Adjustment Percentage, Maximum Annual Limitation on Cost Sharing, Reduced Maximum Annual Limitation on Cost Sharing, and Required Contribution Percentage for the 2027 Benefit Year,” January 29, 2026. https://www.cms.gov/files/document/2027-papi-parameters-guidance-2026-01-29.pdf
- eCFR, 45 CFR 156.236, “Provider access and essential community providers standards for non-network plans.” https://www.ecfr.gov/current/title-45/section-156.236
- eCFR, 45 CFR 155.305, “Eligibility standards” (paragraph (h), catastrophic plans). https://www.ecfr.gov/current/title-45/section-155.305
- eCFR, 45 CFR 156.20, “Definitions” (cost sharing). https://www.ecfr.gov/current/title-45/section-156.20
- 42 U.S.C. 18022(e), catastrophic plans (Affordable Care Act section 1302(e)). https://www.law.cornell.edu/uscode/text/42/18022
- U.S. Departments of Labor, HHS and the Treasury, “FAQs About Affordable Care Act and Consolidated Appropriations Act, 2021 Implementation Part 55,” August 19, 2022. https://www.cms.gov/files/document/faqs-part-55.pdf
- CMS, “2026 Marketplace Open Enrollment Period Public Use Files,” County-Level and State-Level PUFs. https://www.cms.gov/data-research/statistics-trends-reports/marketplace-products/2026-marketplace-open-enrollment-period-public-use-files
- U.S. Census Bureau, 2024 American Community Survey 1-Year Estimates, Table S2701, “Selected Characteristics of Health Insurance Coverage in the United States.” https://data.census.gov/table/ACSST1Y2024.S2701?g=050XX00US48201
- CMS, “Revised Timing of QHP Data Submission and Certification for the 2027 Plan Year,” July 31, 2026. https://www.cms.gov/files/document/revised-py2027-qhp-data-submission-certification-timeline-bulletin.pdf
For general educational purposes; reflects federal statutes, regulations, guidance and data published as of August 2026. Several provisions described here are the subject of pending federal litigation and their status can change without notice. Nothing here is legal or tax advice. Wise Insurance Agency is a licensed insurance agency in the State of Texas, not affiliated with or endorsed by any federal or state agency. Your eligibility and final plan costs are determined by the Marketplace and the issuer.