CMS Implements System Changes to Stop Unauthorized Agent and Broker Marketplace Activity

The Centers for Medicare & Medicaid Services (CMS) implemented new policies aimed at preventing unauthorized changes to Marketplace plans, effective immediately.

From CMS:

"The Centers for Medicare & Medicaid Services (CMS) is committed to protecting consumers from bad actors and ensuring the program integrity of the Federally-facilitated Marketplace (FFM). That’s why CMS is taking additional action to address increases in unauthorized changes in consumers’ enrollments by agents and brokers.

Starting on July 19, 2024, CMS will block an agent or broker from making changes to a consumer’s FFM enrollment unless the agent is already associated with the consumer’s enrollment. Today’s new steps build on CMS’s previous work to protect consumers on the FFM by suspending and terminating agents and brokers who perform unauthorized Marketplace activity.

An agent or broker who is not already associated with a consumer’s enrollment must now take additional steps to update a consumer’s Marketplace enrollment, even with their consent. Unassociated, or “new,” agents and brokers will be required to conduct a three-way call with the consumer and the Marketplace Call Center, or to direct the consumer to submit the change themselves through HealthCare.gov or via an approved Classic Direct Enrollment or Enhanced Direct Enrollment partner website with a consumer pathway."

For more information on these changes, click here to access the full statement from CMS.