Red flags in agent-assisted enrollment stats in the ACA marketplace

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CMS to marketplace agents, May 24, 2023

A May 2023 CMS presentation to health insurance agents and brokers selling ACA marketplace plans opens on a celebratory note. Enrollment in the Open Enrollment Period for 2023 was up 19% year-over-year in the 33 states using the federal exchange, HealthCare.gov. CMS implicitly credited brokers for much of the surge, noting:

The Plan Year (PY) 2023 Open Enrollment Period (OEP) was the strongest year yet for agents and brokers assisting consumers through the Marketplace.

CMS noted that agents* assisted 6.8 million active enrollments in HealthCare.gov in PY 2023, which comes to 70% of the active enrollment total (“active enrollment” excludes 2.5 million auto-re-enrollments, for which agents or other assisters are not credited). CMS further noted that 74,100 agents were registered with HealthCare.gov in PY 2023.

What is CMS doing to quell agent/broker fraud in the ACA marketplace?

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Sen. Wyden puts the heat on CMS

In response to the explosion of unauthorized ACA plan switching and plan enrollment in by rogue agents in the 32 states using the federal exchange (HealthCare.gov), CMS has vowed not only to step up enforcement but to “add new technological protections to prevent such unauthorized activities from occurring.”

The core “technological” problem is pretty simple, as explained by KFF’s Julie Appleby in her story breaking the news of the escalating fraud. To enter an enrollee’s account and make any changes, such as switching her from one plan to another, an agent registered with HealthCare.gov needs only the enrollee’s name, date of birth, and state of enrollment. As Appleby pointed out, the sixteen state-based marketplaces (SBMs) that license agents (MA and RI don’t) “require more information before the account can be accessed” — usually some form of two-factor authorization — and don’t appear to be suffering from large-scale unauthorized broker activity.

CMS is not moving fast enough for Senator Ron Wyman, who this week sent a letter to CMS administrator Chiquita Brooks-LaSure expressing “outrage with reports that agents are submitting plan changes and enrollments in the Federal marketplace without the consent of the people who rely on these plans” and admonishing, “CMS must do more and you must do it now.”