The Centers for Medicare & Medicaid Services (CMS) has announced immediate system changes designed to reduce unauthorized and non-compliant Marketplace enrollments through HealthCare.gov. These updates directly impact how agents and brokers manage Marketplace applications and consumer interactions moving forward.
As compliance oversight continues to increase across the ACA landscape, it’s important for agents to stay informed and follow approved enrollment procedures to protect both consumers and their business.
What’s Changing Immediately?
CMS has confirmed that agents and brokers can no longer add or change a National Producer Number (NPN) directly through HealthCare.gov applications.
Existing NPNs already attached to applications and enrollments will remain unless the consumer removes them. However, going forward, agents and brokers must use approved Enhanced Direct Enrollment (EDE) agent/broker pathways to add or update NPN information, subject to current CMS limitations.
This change reinforces CMS’s ongoing efforts to improve Marketplace integrity and prevent unauthorized activity.
Updated Requirements for Marketplace Call Center Three-Way Calls
CMS has also implemented stricter verification requirements for three-way calls with the Marketplace Call Center.
Effective immediately, agents and brokers must provide all applicants’ Social Security numbers (SSNs) or immigration document information in order for the call to proceed. Without this information, Marketplace representatives will be unable to continue the interaction.
Consumers may still choose to apply or enroll independently online or directly through the Marketplace Call Center.
Important Compliance Reminders for Agents and Brokers
CMS also reiterated several important compliance standards that all Marketplace agents and brokers must follow:
- Agents and brokers may never create or log into a consumer’s HealthCare.gov account on the consumer’s behalf.
- Agents and brokers must never possess or use a consumer’s login credentials.
- Consumers with a Social Security number are required to include it on their Marketplace application. Consumers without an SSN must provide valid immigration documentation.
- Agents and brokers should not identify themselves as Navigators, Certified Application Counselors, or Other Assisters when helping consumers with Marketplace enrollments.
Continue Using Approved EDE Pathways
CMS has indicated additional Marketplace system updates may be coming. In the meantime, agents and brokers should continue using approved EDE agent/broker platforms and always log in using their Federally Facilitated Marketplace (FFM) User ID when assisting consumers with applications and enrollments.
Staying compliant with CMS requirements is critical to protecting your certifications, commissions, and client relationships as Marketplace oversight evolves.
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