Marketplace integrity and consumer protection are at the forefront of the Centers for Medicare & Medicaid Services’ (CMS) mission. Therefore, CMS is taking decisive steps to address the issue of unauthorized changes in consumers’ enrollments by agents and brokers in the Federally-facilitated Marketplace (FFM).
Beginning July 19, 2024, CMS will block any agent or broker from altering a consumer’s FFM enrollment unless they are already associated with the consumer’s account. This measure builds on CMS’s ongoing efforts to safeguard consumers by suspending and terminating agents and brokers who engage in unauthorized marketplace activities.
Marketplace Security Enhanced with New CMS Protocols for Agent and Broker Enrollment Changes
To enhance the security of consumer enrollments, CMS has introduced new protocols for agents and brokers not previously linked to a consumer’s enrollment. These unassociated agents and brokers must now either conduct a three-way call with the consumer and the Marketplace Call Center or instruct the consumer to make changes themselves via HealthCare.gov or through an approved Classic Direct Enrollment or Enhanced Direct Enrollment partner website with a consumer pathway. These measures aim to prevent unauthorized changes and ensure that consumer consent is properly documented and respected.
CMS’s initiative is a response to the increasing number of complaints about unauthorized plan changes and enrollments. In the first half of 2024, CMS received 73,884 complaints regarding unauthorized plan switches, resolving 72,381 (97.97%) of these cases. There remain 1,503 unresolved cases, which CMS aims to address within approximately 18 calendar days. Additionally, CMS received 134,368 complaints about unauthorized enrollments, resolving 130,187 (96.89%) of these cases, with 4,181 still pending. The average resolution time for unauthorized enrollment complaints between January and June 2024 was 53 calendar days.
Marketplace Oversight: CMS Suspends Agents and Brokers for Suspected Fraud
CMS has also taken significant action against agents and brokers suspected of fraud or misconduct. Between June 21 and July 10, 2024, CMS issued 200 suspensions of agent or broker Marketplace Agreements due to reasonable suspicion of fraudulent or abusive conduct related to unauthorized enrollments or plan switches. Suspended agents and brokers are barred from participating in the Marketplace enrollment process and cannot receive commission payments for enrollments made through the Marketplace. CMS continues to monitor and oversee suspicious activities and expects to issue more suspensions as necessary.
These changes are part of CMS’s broader efforts to ensure the integrity and reliability of the Federally-facilitated Marketplace, protecting consumers from malicious actions by bad actors. By tightening controls and increasing oversight, CMS aims to provide a safer, more secure enrollment experience for all users.
Marketplace integrity and consumer protection are at the forefront of the Centers for Medicare & Medicaid Services’ (CMS) mission. Therefore, CMS is taking decisive steps to address the issue of unauthorized changes in consumers’ enrollments by agents and brokers in the Federally-facilitated Marketplace (FFM). Beginning July 19, 2024, CMS will block any agent or broker from altering a consumer’s FFM enrollment unless they are already associated with the consumer’s account. This measure builds on CMS’s ongoing efforts to safeguard consumers by suspending and terminating agents and brokers who engage in unauthorized marketplace activities.
Resource: Centers for Medicre and Medicaid Services, July 19, 2024
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