The Centers for Medicare & Medicaid Services (CMS) continues to exercise its full statutory and regulatory authority to protect the integrity of the Federally-facilitated Marketplaces (FFMs), which includes the FFM platform and State-based Exchanges that operate on the Federal Platform (SBE-FPs), and to protect consumers from unauthorized changes to their FFM enrollments. This includes reviewing and addressing consumer complaints as quickly as possible, updating Marketplace systems to prevent unauthorized changes with as little disruption to consumer access to FFM enrollment as possible, arming consumers with resources and information to help them avoid and report unauthorized plan changes by agents and brokers, and suspending and terminating the Marketplace Agreements of agents or brokers who have engaged in fraud or abusive conduct. The agency continues to conduct robust oversight and monitoring of agents and brokers on the FFM and is evaluating additional technological solutions to preserve access to high-quality, person-centered, and affordable health care coverage – a critical priority for CMS and the Biden-Harris Administration.
Consumer Information
Protecting the millions of people served by CMS programs remains the agency’s top priority. CMS continues to leverage a broad array of resources to warn FFM consumers about potentially fraudulent agent or broker activity and misleading marketing websites.
Consumers who believe they may have been the victim of unauthorized FFM agent or broker activity should call the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325) to resolve any coverage issues promptly.
Technological Updates to Secure Marketplace Systems
Beginning July 19, 2024, CMS began blocking agents and brokers from making changes to a consumer’s FFM enrollment unless the agent or broker is already associated with the consumer’s enrollment. If a consumer would like to work with an agent or broker not already associated with their profile, the consumer must conduct a three-way call with the Marketplace Call Center and the “new” agent or broker. The consumer can also submit the change to their enrollment directly through the Marketplace Call Center, HealthCare.gov, or an approved Classic Direct Enrollment or Enhanced Direct Enrollment partner website with a consumer pathway. Throughout October 2024, CMS will implement updates to enhance the FFM’s ability to block agents and brokers from making changes to a consumer’s FFM enrollment without the consumer’s engagement.
Data Updates
In recent months, CMS has observed a dramatic and sustained drop across several key metrics that indicate that Marketplace system changes that were implemented in July 2024 are having the desired effect of successfully preventing consumers from being switched to different plans or enrolled in coverage without their informed consent. Casework associated with consumer reports of unauthorized plan changes has dropped by approximately 30% since the changes went into effect, and the overall number of plan changes associated with an agent or broker has decreased by nearly 70%.
The changes implemented on July 19, 2024, also served to prevent unauthorized changes to agent and broker commission information. While consumers were often unaware of this type of change when made by agents and brokers, the opportunity to make such changes provided a significant financial incentive for non-compliant agents and brokers to make this type of unauthorized change. Since July 19, 2024, changes to agent or broker commission information have decreased nearly 90%. This means that since the July 19, 2024, system change was made, any updates to the agent or broker on a policy enabling the agent or broker to receive a commission for assisting the consumer have been made exclusively through the Marketplace Call Center, HealthCare.gov, or an approved Classic Direct Enrollment or Enhanced Direct Enrollment partner website with a consumer pathway, ensuring that consumers are aware of and consent to these changes to their Marketplace enrollment commission information.
From January 2024 through August 2024, CMS received 90,863 complaints that consumers had their FFM plan changed without their consent (also known as an “unauthorized plan switch”). The agency has resolved 90,376 (99.45%) of these complaints and remains committed to addressing new and unresolved cases. CMS is currently resolving these cases within approximately 16 calendar days of receipt.
From January 2024 through August 2024, CMS received 183,553 complaints that consumers were enrolled in FFM coverage without their consent (also known as an “unauthorized enrollment”). The agency has resolved 183,095 (99.75%) of these complaints and remains committed to addressing new and unresolved cases. CMS is currently resolving these cases within approximately 52 days of receipt.
From June 2024 through October 2024, CMS suspended 850 agents and brokers’ Marketplace Agreements for reasonable suspicion of fraudulent or abusive conduct related to unauthorized enrollments or unauthorized plan switches. These agents and brokers are now prohibited from participating in Marketplace enrollment, including receiving related commissions.
For additional historical context, please see CMS’ statements from July 19, 2024, and May 6, 2024, as well as the agency’s consumer assistance infographic.
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