The Centers for Medicare & Medicaid Services (CMS) released an Interim Final Rule on Sept. 23 pausing registration of new agents and brokers. This change in coverage removes thousands from federal health insurance marketplace agreements with the Federally Facilitated Exchange or State-Based Exchanges that use the Federal platform (SBE-FPs). These agents and brokers cannot register for Plan Year 2027 participation until the moratorium ends, on Feb. 1, 2027. Comments are due Nov 21, 2026.
At the same time, CMS announced the cancellation of approximately 315,000 federal marketplace enrollments, covering over 760,000 individuals, after confirmation that these enrollments were unauthorized. According to the agency, these individuals enrolled with an agent or broker but lacked verified citizenship or necessary immigration documentation. The White House Fraud Task Force plans to conduct additional verification concerning legal status and income for 419,000 people.
CMS estimates that this policy will save $2.2 billion in federal advanced premium tax credits (APTCs). This announcement is part of the agency’s ‘three-pronged strategy’ to mitigate fraud in the ACA marketplaces, including preventing fraudulent enrollments, eliminating improper enrollments, and strengthening oversight. CMS plans to continue collaborating with health insurance companies to investigate possibly unofficial enrollments, cancel those confirmed as unauthorized, and recoup previous APTC payments.
CMS also will train agents and brokers regarding new requirements and tips on preventing fraud. The interim final rule will require existing brokers and agents to reidentify themselves through federal channels and bars them from being added to applications that consumers should complete for themselves. The rule also will require consumers to electronically authorize any agent or broker activity on their behalf.
Contact Director of Policy Rob Nelb, MPH, at rnelb@essentialhospitals.org or 202.585.0127 with questions.
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