An End to Unauthorized Plan Changes?
In a bid to protect consumers, the Biden administration has taken decisive action against insurance agents who make changes to Affordable Care Act (ACA) or Obamacare plans without consumer consent. This move follows complaints from over 200,000 individuals reporting unauthorized plan changes or enrollment in the first half of this year alone. These modifications were made effective immediately, showcasing the significant importance of this issue.
Ensuring Trusted Brokers Only
The Centers for Medicare & Medicaid Services (CMS) declared that insurance agents would be barred from altering Obamacare enrollments made through healthcare.gov unless they are already associated with a consumer’s policy. Moreover, agents must provide proof of this association or adopt added measures to alter plans, even with the consumer’s agreement. This directive serves as an additional firewall against deceitful practices and prevents unauthorized amendments by brokers and agents.
The Politics of Healthcare
Critics from both sides of the aisle have voiced their concerns. Republicans have alleged that bolstered subsidies under the Biden administration have encouraged brokers and consumers to falsely report incomes, qualifying for ACA tax credits fraudulently. Simultaneously, some Democrats have criticized CMS for not adopting a tougher stance against rogue brokers exploiting the system for commissions.
Protecting the Consumer
Unwanted plan changes can mean higher out-of-pocket costs for consumers. They could also get hit with unexpected tax bills if they are signed up for subsidized plans they don’t qualify for. To ensure consumers’ consent for plan changes, CMS now requires unassociated agents to coordinate three-way calls with the healthcare.gov call center or request clients to make the changes, either via healthcare.gov or approved private sector enrollment websites.
Ellen Montz, a deputy administrator at CMS, assures that while adopting these protective measures, the overall user experience will not change for those consumers working with already associated agents.
Mixed Response from Agents
The new rules have been met with mixed reactions. While some, like Joshua Brooker, founder of PA Health Advocates, applaud the consumer protection aspects of these measures, others are apprehensive about their impact. Ronnell Nolan, president of the Health Agents for America, foresees the requirements being a burden on consumers, worrying about their need to navigate a potentially chaotic marketplace call center to alter their agent.
The directive applies only to existing ACA coverage, not to fresh enrollments. However, the debate over it is expected to continue, particularly with the upcoming open enrollment period at year-end.
A Step Towards Greater Accountability
The pushback against unauthorized enrollment and plan-switching isn’t new, but the issue has surged during the last ACA open enrollment period. Under President Biden’s leadership, a record-breaking 21 million people signed up nationally during the most recent open enrollment period.
In terms of accountability, CMS has resolved 97% of reported unauthorized enrollment or switching complaints. For the first time, enforcement actions were disclosed, with 200 agents or brokers suspended between June 21 and July 10 due to suspicion of fraudulent or abusive conduct.
It’s important to note that these new regulations don’t apply to the 18 states and Washington D.C., which operate their own Obamacare insurance marketplaces. Many of these states already enforce stronger security procedures, like the two-factor authentication on healthcare.gov.