- On July 29, 2024
Earlier this year, it was revealed that due to a flaw in federal Health Insurance Marketplace technology, unauthorized actors with marketplace broker certification could manipulate consumer enrollments and change consumer policies without their knowledge. These rogue agents have steered commissions their way and also wreaked havoc on the health and lives of thousands of affected consumers. In response, the federal Centers for Medicaid and Medicaid Services (CMS), which operates the federal health insurance exchange, recently announced new consumer protections designed to stop the problem.
As of July 19, 2024, CMS will block certified health insurance brokers from making any changes to an enrollee’s Marketplace account unless the broker is already associated with the consumer’s enrollment. Brokers who perform unauthorized enrollments are already terminated from offering services through the marketplace if caught, but this action should help further reduce the problem caused by fraudulent actors.
Suppose an unassociated broker believes they should be allowed to access a customer’s account but is blocked, such as if a broker begins working with a new client who already has marketplace-based coverage. In that case, the broker will be directed to conduct a three-way telephone call with a federal marketplace call center and the consumer. During the call, the consumer must provide verified consent for the new broker to access their account. Alternatively, consumers may authorize a new broker to service their account through www.healthcare.gov or an approved classic direct enrollment or enhanced direct enrollment partner. In announcing the new policy, CMS notes it plans to continue to monitor any malicious activity on the marketplace, and it will take additional appropriate action against agents and brokers engaged in misconduct.