Published by ProtectHealth
Las Vegas, NV - October 10, 2024
© 2024-2025 ProtectHealth
On July 24, multiple US Senators introduced the Insurance Fraud Accountability Act. This legislation aims to protect consumers from fraudulent health insurance practices by targeting agents and brokers who enroll or switch consumers into Affordable Care Act (ACA) plans without their consent. Offenders could face criminal penalties and fines up to $200,000 for these unauthorized actions.
What Nevada Consumers Need to Know
Nevada’s exchange is managed by Nevada Health Link, which is the Silver State Health InsuranceExchange. Nevada no longer uses HealthCare.Gov, which is why the actions mentioned in the above reference bill were introduced to protect. While Nevada is regulated by CMS, (The Centers for Medicare and Medicaid Services) Nevada manages its exchange independently of HealhCare.gov. There are many other states that also manage their own exchange, and the above mentioned actions also does not apply to many of those states as well.
Beginning in plan year 2020, Nevada Health Link has protected consumers, agents and brokers in Nevada by making this type of behavior impossible. This is because Nevada agents and brokers must confirm the change to become the agent or broker for that consumer using a recorded phone call to Nevada Health Link, with the consumer on the line. The only other method for a consumer to be assigned to a new agent or broker in Nevada is for the consumer to make the request themselves. That means consumers should feel confident that this type of behavior is not happening in Nevada, and their information is safe and secure from unscrupulous agents and brokers.
In States Managed by HealthCare.Gov.
In response to these concerns, the Centers for Medicare and Medicaid Services (CMS) issued new rules on July 19, prohibiting agents and brokers from switching ACA plans for consumers without their consent. CMS also mandated that any broker making changes to a consumer’s ACA plan must have enrolled the individual in the first place. For new consumers, or those who were not originally enrolled by the same broker, the agent must now take additional steps, including conducting a three-way call with the consumer and a Marketplace representative or allowing the consumer to make changes directly.
These changes come in response to over 200,000 consumer complaints received by CMS sinceJanuary. The complaints involved allegations that brokers either switched individuals’ health plansor enrolled them into ACA plans without their knowledge. CMS has resolved most of these cases,suspending 200 agents and brokers suspected of fraud or abuse.
The new legislation and CMS regulations are intended to curb these unauthorized actions whileensuring that low-income consumers, who rely on ACA plans, continue to have access to coverage.Last fall, a record 21.3 million people enrolled in ACA plans, with over 5 million new enrollees.Safeguarding this process is crucial, according to healthcare policy experts, who warn thatadditional barriers should not hinder legitimate access to ACA plans.
In its recent statement, CMS affirmed its commitment to ensuring the integrity of the ACA marketplace and protecting consumers from fraudulent behavior. The agency clarified that agents and brokers working with new clients must adhere to stricter procedures when making changes to existing health coverage. These steps aim to prevent further unauthorized enrollment or switching.
For consumers, it’s important to understand the distinction between agents and brokers. Agents typically represent a single insurer, while brokers may work with several companies. Regardless, both must be licensed and follow strict guidelines when offering ACA plans. Consumers should not be charged any additional fees by agents or brokers, who receive commissions directly from the insurance companies.
Consumers who qualify for premium tax credits and other savings based on their family size and income must be enrolled through the official ACA marketplace by their agent or broker, ensuring they receive the correct subsidies and coverage.
