Custom AgentBroker Resources
Jun 20, 2024

Unauthorized ACA enrollments on the rise

Blue Cross and Blue Shield of Kansas City (Blue KC) thanks you for being compliant in following processes for enrolling clients in ACA plans. Those processes include:

  • Obtaining documentation of consent from clients before enrolling them in a Federally Facilitated Marketplace plan. The Centers for Medicare & Medicaid Services (CMS) put this requirement in place in 2023.
  • Checking a client’s current account status before submitting a new plan. If an active account exists, a new application for the same policy may not be written.

Increased cases of unauthorized ACA plan switches nationwide

These reminders come on the heels of CMS identifying an increase in cases of unscrupulous health insurance brokers switching consumers into ACA plans without the consumers’ express permission. This practice, referred to as an unauthorized plan switch, results in cancellation or termination of the consumers’ desired policies.

Many consumers are unaware of the switch until they attempt to use the desired policy to see a doctor or fill a prescription and are denied. Consumers are contacting the Marketplace Call Center to request reinstatement of the desired plan through a Health Insurance Casework System (HICS) case.

While the issue has occurred nationwide, locally we have seen little evidence or impact.

For more information about the authorization process required before enrolling clients in ACA plans, please visit HealthSherpa’s Summary of CMS Guidance on New Consent Rules.

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