CMS announces system changes to stop unauthorized agent Marketplace activity
The Centers for Medicare & Medicaid Services (CMS) announced a system change to Healthcare.gov that will block an agent from making changes to a consumer’s federal Marketplace enrollment unless the agent is already associated with the consumer’s enrollment. Agents not already associated with a consumer’s enrollment must now take additional steps to update a consumer’s enrollment, including conducting a three-way call with the consumer and the Marketplace Call Center. The change is being implemented to address the increases in unauthorized enrollments and plan switching by agents.
CMS will also implement a new weekly process to identify and cancel new (often duplicate) enrollments submitted by agents and brokers who are not associated with the consumer’s enrollment. Consumers and agents will be made aware of these cancellations when they receive a notice from the issuer cancelling the invalid enrollment.
For technical information about the changes associated with this update and impacts to issuers, please see CMS’s Release Notes for NPN Switching.
Why the change?
CMS reported that in the first six months of 2024 the Marketplace received 73,884 complaints of unauthorized plan switches and 134,368 complaints of unauthorized enrollments. Since June, CMS has issued 200 suspensions of agent or broker Marketplace Agreements for reasonable suspicion of fraud or abusive conduct related to unauthorized enrollments and plan switching, prohibiting such agents from participating in the Marketplace enrollment process.
We expect these changes to significantly decrease new unauthorized enrollment activity through the Marketplace.
