In recent months, thousands of nationwide marketplace clients have found their ACA health insurance coverage switched without consent. This includes some cases in Texas, where unauthorized changes have led to confusion and missing agent commissions. The Centers for Medicare & Medicaid Services (CMS) is taking steps to resolve these issues and ensure agents rightfully earn their commissions while protecting clients from fraudulent plan changes.

Here’s what agents in El Paso need to know to safeguard their clients and commissions from unauthorized ACA plan switching.

What Is an Unauthorized Plan Switch?

Some unethical agents, often called “bad apple” agents or rogue call centers, have made illegal policy switches for clients receiving ACA coverage through the federal marketplace HealthCare.gov. These agents change plans without the client’s or current agent’s knowledge or consent. This practice is done to collect commissions, but it leaves clients with coverage they did not choose.

Who Is Being Affected?

CMS reports that unauthorized ACA plan switches primarily affect low-income consumers who enroll through the Federally Facilitated Marketplace (FFM). Many clients qualify for $0-premium plans, so they don’t receive a monthly bill. As a result, they may not notice when their plan has been switched until they need to use their coverage. At this point, they could face higher deductibles, out-of-network doctors, or uncovered medications.

CMS received over 73,000 complaints about unauthorized plan changes in the first half of 2024. While most cases have been resolved, this issue highlights the importance of vigilance in protecting clients in El Paso.

CMS’ Response to Fraud

CMS has been working to address fraud in the marketplace by implementing several new measures to protect consumers:

• Suspending rogue agents and call centers: CMS is taking action against agents and platforms that engage in fraudulent activity, including suspending Enhanced Direct Enrollment (EDE) platforms under investigation.
• Enhanced enrollment protections: Agents are now required to collect written consent from clients before making any changes to their plans, and CMS has masked sensitive information, such as Social Security numbers, on HealthCare.gov to reduce fraud.
• Blocking unauthorized changes: As of July 2024, agents cannot change a client’s plan unless they are the agent of record. CMS has also introduced measures to prevent overlapping enrollments that rogue agents have used to collect commissions.

How to Protect Your Clients in El Paso

As an agent, you are your client’s best advocate. Protecting them from unauthorized ACA plan switching is essential for maintaining their trust and securing your commissions. Here are a few steps you can take to safeguard your clients:

• Educate your clients: Ensure your clients fully understand their ACA plan, including its name, costs, in-network providers, and coverage. This way, they can easily identify if any changes have been made without their consent.
• Provide resources: Give your clients access to resources that help them find information on their plan and the marketplace so they can verify details on their own if needed.
• Stay transparent: Let your clients know you will never change their plan without their written consent, and encourage them to contact you immediately if they notice any discrepancies in their coverage.

Reporting Unauthorized Plan Changes

If you discover that a client’s ACA plan has been switched without their consent, report it to the appropriate authorities. In Texas, clients can call the Marketplace Call Center at 1-800-318-2596 to report unauthorized activity on their HealthCare.gov account. You can also guide your clients through restoring their previous coverage.

For agents, organizations like Health Agents for America (HAFA) offer resources and instructions for reporting fraud to CMS, state regulators, and carriers.

Protecting El Paso Clients from Fraud

Fraudulent plan changes can lead to financial and health-related issues for your clients, such as losing access to their preferred doctors or unexpected medical bills. As an agent in El Paso, your role is to help clients stay informed and take action when they are targeted by unauthorized plan switches. By staying compliant with CMS guidelines and educating your clients, you can protect their health and commissions.

Need help protecting your clients from unauthorized ACA plan switching? Contact Plans for Life at 915-591-1957 or visit our website at www.plans4life.com. We’re here to support El Paso agents and ensure your clients get the coverage they need without surprises.