Unauthorized switching of Affordable Care Act plans appears to have tapered off in recent weeks based on an almost one-third drop in casework associated with consumer complaints, say federal regulators. The Centers for Medicare & Medicaid Services, which oversees the ACA, credits steps taken to thwart enrollment and switching problems that triggered more than 274,000 complaints this year through August. Now, the annual ACA open enrollment period that began Nov.
1 poses a real-world test: Will the changes curb fraud by rogue agents or brokerages without unduly slowing the process of enrolling or reducing the total number of sign-ups for 2025 coverage? "They really have this tightrope to walk," said Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University. "The more you tighten it up to prevent fraud, the more barriers there are that could inhibit enrollment among those who need the coverage." CMS said in July that some 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 barred two of about a dozen private sector online-enrollment platforms from connecting with healthcare.gov over concerns related to improper switching.
And CMS has suspended 850 agents suspected of being involved in unauthorized plan-switching from accessing the ACA marketpla.
