Unauthorized switching of Affordable Care Act plans appear to have eased in recent weeks due to a nearly one-third drop in filings associated with consumer complaints, according to federal regulators. The Centers for Medicare & Medicaid Services, which oversees the ACA, credits steps taken to thwart enrollment and switching problems with triggering more than 274,000 complaints this year through August.
Now the ACA Annual Open Registration The period that began on November 1 constitutes a concrete test of whether the changes will curb fraud committed by dishonest agents or brokerages without unduly slowing down the registration process or reducing the total number of registrations for the 2025 coverage?
“They really have a tightrope to walk,” said Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University. “The more you tighten the rules to prevent fraud, the more barriers there are that could hinder enrollment for those who need the coverage.”
CMS said in July that certain types of policy changes — those in which the agent is not “affiliated” with the existing plan — will face more requirements, such as a three-way call with the consumer, broker and a Healthcare.gov call. center representative.
In August, the agency banned two of about a dozen private-sector online registration platforms from connecting to Healthcare.gov due to concerns about inappropriate switching.
And CMS suspended access to the ACA marketplace for 850 agents suspected of being involved in an unauthorized plan change.
However, the crackdown could make registration more complex and slow down the process. For example, a consumer may have to wait in line for a three-way call or struggle to find a new agent because the one they previously worked with has been suspended.
Since phone lines with Healthcare.gov staff are already busy — especially in mid-December — agents and policy analysts are advising consumers not to hang around this year.
“Get off to a flying start,” said Ronnell Nolan, president and CEO of Health Agents for America, a professional organization of brokers.
Meanwhile, reports are emerging that some malicious entities are already finding workarounds that could compromise some of the anti-fraud protections CMS has in place, Nolan said.
“At the end of the day, fraud and abuse still happens,” Nolan said.
Brokers help the majority of people who actively enroll in ACA plans and receive a monthly commission from insurers for their efforts. Consumers can compare plans or sign up online at federal or state marketplace websites. They can also seek help from people called assistants or navigators – certified assistants who do not receive commissions. Under a “Find Local Help” button on the ACA’s federal and state websites, consumers can search for brokers or navigators nearby.
CMS says it has “ramped up support operations” at its 24/7 Healthcare.gov Marketplace call centers in anticipation of increased demand for three-way calls, and expects “ minimal wait times,” said Jeff Wu, deputy policy director for the CMS Center for Consumer Information and Insurance Oversight.
Wu said these three-way calls are only necessary when an agent or broker not already associated with a consumer’s enrollment wants to change that consumer’s enrollment or terminate their coverage. It does not apply to people seeking coverage for the first time.
Organizations paid by the government to offer navigation services have a dedicated phone line for the federal market, and callers currently do not experience long waits, said Xonjenese Jacobs, director of Florida Covering Kids & Families, a program based at the University of South Florida which coordinates registrations statewide through its Covering Florida navigation program.
Navigators may participate in three-way calls if the consumer’s situation requires it.
“Since we have our fast line, there is no increase in wait time,” Jacobs said.
The problem of unauthorized changes has been around for some time, but it gained momentum during last year’s open enrollment season.
Brokers generally attribute much of the problem to the ease with which dishonest agents can access ACA information in the federal marketplace, needing only name, date of birth and state of residence of a person. Although federal regulators have worked to tighten that access with the three-way conversation requirement, they have failed to institute what some agent groups say is necessary: two-factor authentication, which could involve a code accessible by a consumer via a smartphone.
Unauthorized changes can cause many problems for consumers, from higher deductibles to landing in new networks that don’t include their preferred doctors or hospitals. Some people received tax bills even though unauthorized policies had premium credits for which they were not eligible.
The unauthorized changes were a political liability for the Biden administration, a stain on two years of rule. register ACA registration. This practice has drawn criticism from lawmakers on both sides; Democrats have demanded more oversight and sanctions against dishonest agents, while Republicans have said fraud attempts are fueled by the Biden administration’s moves that allowed for more generous measures. premium subsidies and special registration periods. The fate of these enhanced subsidies, which are about to expire, will be decided by Congress next year, when the Trump administration takes power. But the bonuses and subsidies that come with the 2025 plans that people are signing up for now will remain in effect all year.
This year’s measures to thwart unauthorized registrations apply to the federal market, used by 31 states. Other states and the District of Columbia maintain their own websites, many of which have additional layers of security in place.
For its part, CMS affirms that its efforts are bearing fruit, highlighting the 30% drop in complaint files. The agency also noted a 90% drop in the number of times one agent’s name was replaced with that of another, which it said indicates that it is more difficult for competing agents to stealing from customers to earn monthly commissions paid by insurers.
Still, the decision to suspend 850 agents was met with pushback from the agent groups that initially brought the issue to the attention of federal regulators. They claim some of the defendants were suspended before they had a chance to respond to the allegations.
“There will be a number of agents and brokers who will be suspended without due process,” said Nolan, of the health agents group. She said she was calling for increased protections against unauthorized changes and that two-factor authentication, like that used in some domestic markets or in the financial sector, would be more effective than what has been done.
“We now have to jump through so many hoops that I’m not sure we’re going to survive,” she said of officers in general. “They’re just throwing things at the wall to see what sticks when they could just be taking a two-factor approach.”
The agency did not respond to questions seeking details about how the 850 officers suspended since July were selected, the states they were in, or how many had their suspensions rescinded after providing additional information.
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