Leading up to marketplace open enrollment, CMS issued guidance to insurers Oct. 19, encouraging greater oversight of agents and brokers.
The memo focuses on issuers using the federally facilitated exchange. CMS expects issuers to follow much of the guidance beginning Nov. 1, when the enrollment period kicks off.
CMS recommended that issuers have their agents and brokers record consumer calls “to capture interactions involving plan comparison and selection, enrollment, sales and marketing.” CMS said this practice should apply to all agents and brokers who enrolled at least 100 plan year 2026 policies with a parent organization by Nov. 1. For those who did not meet this threshold, this guidance should apply by March 1, 2027, or once they enroll at least 100 plan year 2027 policies with a parent organization — whichever comes first. These recordings should play a role in insurers’ monitoring and oversight, the memo said.
Ahead of contract year 2023, CMS issued a final rule that instituted call-recording requirements for third-party marketing organizations working with Medicare Advantage and Part D plans. The agency’s recent memo said that “the marketplace can build on this model.”
“These recordings are used to protect Medicare beneficiaries from misleading or high-pressure sales tactics, ensure [agents and brokers] provide accurate plan benefit information and inform audits,” the memo said.
CMS’ other recommendation for issuers is to regularly evaluate enrollment records, roughly on a monthly basis. The agency will begin providing qualified health plan issuers with a new recurring file that lists plan year 2027 policies associated with open data-matching issues — or inconsistencies between data on marketplace insurance applications and information from other trusted sources — and associated agent and broker national producer numbers.
Issuer reviews should encompass these open data-matching issues. CMS noted that an open data-matching issue alone does not indicate broker noncompliance.
Issuers should assess agents and brokers “with patterns that suggest noncompliance or misconduct,” including those with disproportionately high rates of enrollments tied to open data-matching issues. Action against noncompliant agents and brokers should usually take place within one month. For agents and brokers considered “significantly noncompliant” with suspected unauthorized enrollments, issuers should report those policies to CMS.
“Unfortunately, many issuers are not adequately monitoring the actions of, and taking action against noncompliant [agents and brokers] on a timely basis, including by suspending commission payments and terminating appointed agents and brokers, when appropriate,” the memo said.
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