Additional Actions CMS is Taking to Fight Fraudulent Changes to Consumers’ Enrollments

On Friday, July 19, 2024, CMS announced a new change to Enhanced Direct Enrollment (EDE) and Classic Direct Enrollment (DE) pathways that will block an agent or broker from making changes to a consumer’s Federally-facilitated Marketplace (FFM) enrollment unless the agent is already associated with the consumer’s enrollment. Enrollees who want to continue to work with the agent or broker who is already associated with their enrollment will experience no change in the consumer experience.

An agent or broker who is not already associated with a consumer’s enrollment will be required to conduct a three-way call with the consumer and the Marketplace Call Center at 1-855-788-6275, or to direct the consumer to submit the change themselves through HealthCare.gov or via an approved Classic Direct Enrollment or Enhanced Direct Enrollment partner website with a consumer pathway. When calling 1-855-788-6275, agents and brokers will be prompted to enter their National Producer Number (NPN) to speak to a representative. Remember the consumer must be on the line to provide the Marketplace Call Center authorization to speak with an agent or broker. The consumer may elect to authorize the agent or broker for the single call only or for up to one year.

During a three-way call with the Marketplace Call Center, the call center representative will typically walk through the application questions and the plan selection process in order to make the requested update and ensure that the agent or broker is on the enrollment as intended.

The Marketplace Call Center is currently experiencing minimal to no wait times to connect to a representative. However, agents and brokers should prepare the consumer to address relevant questions, which may take additional time.

Can I create a new application for the consumer instead of calling the Marketplace Call Center?

No. In addition to these front-end changes that impact all EDE/DE agent and broker pathways, CMS will also monitor situations in which an agent or broker submits a new, duplicate application for the consumer as an attempt to change the agent or broker associated with the consumer’s enrollment. New enrollments created for an existing Marketplace consumer through a separate application will be cancelled shortly after their creation. Agents and consumers will not be immediately made aware of cancellations that occur through this method. However, issuers are required by regulation to notify the consumer of the cancellation of the duplicate enrollment.