CMS Statement on System Changes to Stop Unauthorized Agent and Broker Marketplace Activity

[Duaine]

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 the link below to access the full statement from CMS.
[EXTERNAL LINK] - CMS Statement on System Changes to Stop Unauthorized Agent and Broker Marketplace Activity | CMS

 

[InsuranceGuy29]

God this has become an effing circus. No, let’s not exercise some common and make it easier to do this. For instance, they could send the person a link authorizing a new agent switch. No, no, let’s waste everyone’s time on the phone lines, sitting there waiting to talk to a customer service rep for an hour. Another “genius” idea from CMS.

 

[hockeyday]

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 the link below to access the full statement from CMS.
[EXTERNAL LINK] - CMS Statement on System Changes to Stop Unauthorized Agent and Broker Marketplace Activity | CMS

So what happens during open enrollment season

 

[Duaine]

CMS cracks down on ACA brokers to prevent plan switching​

Agents and brokers connecting consumers with Affordable Care Act plans now have to jump new hurdles to change their coverage.
[EXTERNAL LINK] - CMS cracks down on ACA brokers to prevent plan switching

 

[Will305]

I was looking to start doing ACA for the first time in my career and I thought MAPD was bad. for agents doing ACA, how significant this is to your production?

 

[sshafran]

I was looking to start doing ACA for the first time in my career and I thought MAPD was bad. for agents doing ACA, how significant this is to your production?

I do Medicare and always have. Got tired of referring out ACA.

It shouldn't affect me much since I'm not changing people's plans and actively advertising. I'm writing policies when spouses retire, or when kids of clients lose jobs.... Etc. I have under 20 ACAs so it's just not a big deal yet but I could see it being a big deal if I were marketing for SEP changes.

 

[Yagents]

Like he said. Only a pain if person has current ACA plan with another agent on the policy

 

[sshafran]

Like he said. Only a pain if person has current ACA plan with another agent on the policy

Someone said that the Sherpa way of sending it to the to finalize worked pretty well. Haven't tried it yet obviously.

 

[Will305]

I do Medicare and always have. Got tired of referring out ACA.

It shouldn't affect me much since I'm not changing people's plans and actively advertising. I'm writing policies when spouses retire, or when kids of clients lose jobs.... Etc. I have under 20 ACAs so it's just not a big deal yet but I could see it being a big deal if I were marketing for SEP changes.

make sense. that's what I do exactly just refer out ACAs. same scenario spouses aging in losing employer plans. Im assuming ACA callcenters are flippers just like MAPDs. they are going to be the ones suffering.

 

[wehotex]

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 the link below to access the full statement from CMS.
[EXTERNAL LINK] - CMS Statement on System Changes to Stop Unauthorized Agent and Broker Marketplace Activity | CMS

How come they can’t do something similar for Medicare Advantage?