Unscrupulous insurance agents have been making unauthorized changes to consumers’ insurance plans. New restrictions from the Centers for Medicare and Medicaid Services (CMS) are meant to prevent these unethical switches from happening.
This change is needed for consumer protection but will add an extra step for agents and brokers working on behalf of consumers.
Here are all the details to know.
CMS: Updated Enrollment Protection
As of July 19, 2024, CMS will block any agent or broker from making changes to a consumer’s FFM enrollment unless the agent is already associated with the consumer’s enrollment.
How big of a problem is this? According to CMS stats, 134,368 complaints of unauthorized switching were received by CMS in the first six months of 2024. Between June 21 and July 10 of 2024, CMS suspended 200 agent or broker Marketplace Agreements “due to reasonable suspicion of fraud or abusive conduct related to unauthorized enrollments or unauthorized plan switching.”
Unauthorized switching can incur unexpected IRS penalties or taxes as well as place consumers in a plan which their regular doctors don’t participate in, disrupting care.
We think the problem is larger than the number of complaints. In fact, over 500 of our clients were switched out of their plans without their knowledge or had an unscrupulous insurance agency assign themselves as the “Agent of Record.”
For the record, we vehemently disagree with any insurance agent who would act in such an unethical manner for their own gain.
Marketplace Enrollment Changes
So what does this mean for you? There are two aspects of this announcement:
- Agent/Broker Association Requirement: An agent or broker must be associated with your existing enrollment to make changes. If you wish to use a new agent or broker, they must:
- Conduct a three-way call with you and the Marketplace Call Center.
- Or guide you to submit changes yourself through HealthCare.gov or via an approved Direct Enrollment partner website.
- Monitoring and Action Against Misconduct: CMS will continue to monitor and take action against agents and brokers who engage in unauthorized activities.
Note that this change only applies to the 32 states served by Federally facilitated Marketplaces. Most of the marketplaces in the other 18 states and District of Columbia use online security practices, such as two-factor authentication, that healthcare.gov doesn’t.
Navigate These Changes With eQuoto Insurance
We stand ready to help our customers attain the insurance right for their needs. Here’s how we can help:
- Existing Clients: If you are already associated with our agency, we can continue to manage your enrollment and make necessary updates without any interruption.
- New Clients: If you are considering switching to our agency, we will facilitate the required three-way call or guide you through the process to ensure a seamless transition.
- Support and Resolution: If you encounter any issues or suspect unauthorized activity, our team will help you promptly contact the Marketplace Call Center and resolve any concerns.
Additional Information
CMS put out a brief information sheet regarding unauthorized access, you can access it here.
Ads on the Web and social platforms can be scams. For absolute safety, look for an agent using “find local help” at healthcare.org or call the Marketplace Call Center; 1-800-318-2596.
Anyone who has had their plan switched or been added to a plan without consultation should call the number above to:
- Make sure the unauthorized plan is canceled
- Make sure you’re enrolled in a plan
- Have inaccurate costs repaid to you
- Get corrected tax forms
Your Trusted Partner
eQuoto Insurance is committed to safeguarding your interests and providing expert guidance through these regulatory changes. Reach out to us for any assistance or to discuss your enrollment options securely and confidently.
