CMS To Increase Oversight On Exchange Brokers

An article from

Dive Brief:

• The CMS is continuing to crack down on health insurance agents and brokers who fraudulently enroll beneficiaries in Affordable Care Act marketplace plans.
• In a proposed rule released Friday, the agency could suspend brokers beginning next year from the exchange entirely if they violate marketplace rules, in a bid to prevent agents from switching consumers’ plans without their consent.
• The proposal comes months after the CMS said agents couldn’t make changes to a consumer’s enrollment unless they’re already associated with that beneficiary, following increasing complaints about unauthorized plan changes. 

Dive Insight:

Brokers and agents are supposed to help consumers find health plans that fit their needs. But, since the beginning of open enrollment for the 2024 plan year, the CMS has recorded a growing number of complaints from enrollees about applications being submitted without their consent, with inaccurate information or without their review.

A large portion of the complaints include unauthorized changes to enrollees’ plans, which can affect whether they can access care, according to the CMS. Incorrect data about enrollees, like their income, could also result in a consumer receiving a zero-premium plan when they’re not eligible — leaving them on the hook for payments once they file their taxes. 

The proposed rule aims to crack down on broker abuses by suspending them from transacting information with the exchange if they’re found to “pose unacceptable risk” to the accuracy of eligibility determinations, exchange operations or its information technology systems.

The proposal also seeks to modify a form that agents and brokers use to obtain consumer consent. The update would include a section to document whether an enrollee has reviewed their application, as well a script brokers could use to meet the requirements via audio recording.

In addition to the broker regulations, the rule proposes a change that aims to keep beneficiaries enrolled in their plans if they haven’t paid their full premium. The proposal would allow insurers to adopt a fixed-dollar payment threshold of $5 or less, adjusted for inflation, where they wouldn’t have to trigger a grace period or terminate enrollment. 

The CMS is accepting comments on the proposed rule until Nov. 12.