CMS: Payers that cut or reduce agent commissions are violating the ACA

Payers that reduce or eliminate compensation for insurance agents and brokers who help enroll people in ACA plans during a special enrollment period are in violation of the ACA, according to a FAQ published by CMS on June 7.

The move comes after reports of Bright Healthcare, Oscar Health, Molina Healthcare and some Blue Cross companies cutting or limiting agents' commissions after record ACA enrollment earlier this year.

The federal agency wrote that it has "become aware" of the practice and that these arrangements are in violation of the guaranteed availability provisions of the Affordable Care Act.

The provisions in Section 2702 of the Public Health Service Act were added to the ACA to generally require payers to accept "every employer and individual in the state that applies for such coverage." The requirement applies to payers who offer non-grandfathered policies in group or individual markets, through or outside of ACA marketplaces. In the individual market, payers are required to guarantee coverage during the annual open enrollment period to all individuals and during a special enrollment period to an eligible individual. 

Payers' normal process for receiving applications and offering coverage "must also be open to individual market consumers for open enrollment period and special enrollment period enrollments, as applicable," the FAQ said. 

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