March 13, 2026
Administrator Mehmet Oz, MD
Centers for Medicare & Medicaid Services
Department of Health and Human Services
P.O. Box 8013
Baltimore, MD 21244-8013
Submitted electronically
Re: CMS-9883-P – Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health
Dear Administrator Oz:
The Infusion Access Foundation appreciates the opportunity to comment on the Centers for Medicare & Medicaid Services’ proposed changes to Affordable Care Act (ACA) marketplace plan requirements.
The Infusion Access Foundation advocates for patients with complex, chronic, and rare conditions who rely on consistent access to specialty medications and clinician-administered therapies, including infusions and specialty injections delivered in physician offices, hospital outpatient departments, infusion centers, and home infusion settings. Our community includes patients who frequently depend on coordinated care from specialists and other providers to manage serious and often lifelong medical conditions.
We are concerned that the proposal to allow marketplace plans with little or no traditional provider networks could create significant risks for patients and consumers. While we recognize the importance of expanding coverage options and lowering costs, coverage must provide meaningful access to care. Insurance that exists primarily on paper, but does not ensure realistic access to providers, may leave patients financially exposed and unable to obtain necessary treatment.
Risk of Coverage Without Meaningful Access to Care
Allowing marketplace plans that do not maintain defined provider networks could result in consumers enrolling in coverage that does not provide practical access to physicians, hospitals, specialists, or infusion providers. Patients may believe they have comprehensive coverage, only to discover that the providers they need are effectively unavailable through their plan.
This concern is particularly significant for patients who require provider-administered therapies. Many specialty medications are delivered through infusion or injection in clinical settings such as infusion centers, hospital outpatient departments, physician offices, or through home infusion services. These treatments require trained clinicians, appropriate facilities, and coordinated care with specialists.
Without meaningful provider networks, patients who require these therapies may face significant barriers locating clinicians willing or able to provide treatment under the terms of their plan. In practice, this could result in patients being forced into out-of-network care or facing unaffordable costs in order to access medically necessary treatments.
For patients managing chronic or complex conditions, continuity of care with experienced providers is essential. Policies that weaken network adequacy protections risk disrupting these relationships and introducing new barriers to treatment.
Potential for Consumer Confusion and Deceptive Coverage
The Infusion Access Foundation is also concerned that plans without meaningful provider networks may create confusion for consumers navigating marketplace coverage options. Many individuals shopping for health insurance reasonably assume that enrolling in a marketplace plan ensures access to a network of participating doctors, hospitals, and specialty providers.
Plans that lack meaningful networks could undermine this expectation. Consumers may not fully understand the implications of enrolling in such coverage until they attempt to seek care.
This risk is particularly concerning for individuals who enroll while healthy but experience a new diagnosis later in the plan year. A person who initially enrolls in what appears to be affordable coverage may only discover after becoming ill that the plan does not provide practical access to specialists or treatment facilities.
In this respect, plans without meaningful provider networks could create situations similar to the well-documented problem of “ghost networks,” in which provider directories or plan structures give the appearance of access while patients struggle to identify providers who are actually available or able to deliver care under the terms of the plan. Policies that inadvertently replicate or worsen these dynamics would be deeply concerning for patients.
Compounding Instability in the Marketplace
These concerns arise during a period of significant uncertainty in the ACA marketplace. Ongoing policy debates around enhanced ACA subsidies and other federal health policy changes have already created anxiety for many patients and families who rely on marketplace coverage.
Patients with chronic and complex conditions often depend on stable, predictable coverage to maintain access to specialists and ongoing treatment. Introducing new plan structures that could further complicate plan selection or weaken provider access protections may increase confusion and financial risk for consumers.
For patients who rely on infusion therapies and other specialty treatments, disruptions in coverage or provider access can have serious consequences for disease management and long-term health outcomes.
The Importance of Meaningful Consumer Protections
Marketplace coverage should ensure that patients can realistically access the care their insurance promises to cover. While innovation in plan design may expand options for some consumers, it is essential that marketplace policies continue to prioritize transparency, network adequacy, and meaningful access to care.
CMS should carefully evaluate the potential patient access implications of allowing plans without meaningful provider networks and consider whether additional consumer protections, disclosure requirements, or network adequacy standards are necessary to prevent unintended harm.
Conclusion
The Infusion Access Foundation supports efforts to improve affordability and expand consumer choice in the health insurance marketplace. However, policies that weaken network adequacy protections risk creating coverage that appears affordable but fails to provide meaningful access to care.
Patients should not discover only after becoming ill that their insurance does not provide realistic access to doctors, specialists, hospitals, or infusion providers. Marketplace coverage must ensure that patients can obtain the care they need when they need it.
For these reasons, the Infusion Access Foundation urges CMS to carefully reconsider the proposed policy and ensure that any final rule includes strong consumer protections that preserve meaningful access to healthcare providers and medically necessary treatments.
Sincerely,
Alicia Barron. LGSW
Executive Director
Infusion Access Foundation