After another record-breaking enrollment period, CMS is warning states using HealthCare.gov to be wary of unscrupulous agents switching consumers’ ACA plans without consent to pocket commissions. Also this week the federal agency released a final rule setting network adequacy standards for Marketplace plans and giving states the option to increase access to routine adult dental services in 2027.
In reporting from the Kaiser Family Foundation, CMS is warning that some consumers enrolled in Marketplace plans are finding themselves involuntarily transitioned from one plan to another, raising concerns about their access to healthcare providers and medication. Additionally, some consumers are encountering substantial IRS bills for overdue taxes as a result of the unapproved switching.
The 2025 Notice of Benefit and Payment Parameters final rule released April 2 also extends the special enrollment period (SEP) for consumers with household incomes at or below 150% of the FPL to enroll in Marketplace coverage in any month rather than the open enrollment period (OEP) and aligns OEP dates across almost all Marketplaces to generally begin on November 1 and end no earlier than January 15, with the option to extend the OEP beyond January 15.
More than 21 million Americans signed up for high-quality, affordable health care coverage through the ACA Marketplaces in 2024. Some are finding their plans were switched without their permission.
Ronnell Nolan, president of Health Agents for America, a nonprofit trade association representing independent insurance brokers characterized the situation also alarming the Centers for Medicare and Medicaid Services (CMS)
It’s rampant. It’s horrible.
Leslie Shields, an insurance broker in Fort Worth, Texas agreed,
It’s happened in the past, but now it’s literally the worst I’ve seen.
In KFF’s coverage, Adam Bercowicz, a licensed independent broker in Florida estimated he’s had 300 to 400 policies overtaken by other agents not connected to his staff in recent months and explained how he watched the scheme in real time,
If I saw one of my clients was stolen from me at, let’s say, 11:57 p.m., I put myself back on. And by 11:58 — a minute later — they were already switched back.
Get the latest guidance and data from CMS regarding the 2024 Unauthorized Plan Switch
Get the fact sheet from CMS on HHS Notice of Benefit and Payment Parameters for 2025 Final Rule
Leave a Reply
You must be logged in to post a comment.