CMS issues new guidance on ACA insurers as open enrollment looms

Agent organizations are speaking out regarding new federal guidance for health insurers operating on the federally facilitated Affordable Care Act marketplace.

The Centers for Medicare & Medicaid Services released guidance this week in an attempt to strengthen agent and broker oversight for the 2027 plan year. Open enrollment for the 2027 ACA plan year begins Nov. 1.

The guidance includes two significant recommendations:

1. Call recording. CMS recommends that insurers direct appointed agents and brokers to record consumer calls involving plan comparisons, enrollment, marketing and sales. The suggested implementation dates are Nov. 1 for agents and brokers with 100 or more 2026 policies with a parent organization, and March 1, 2027, for agents and brokers below that threshold, or earlier if they reach 100 PY2027 policies with that parent organization. Enrollment monitoring. CMS recommends increased monitoring of enrollment patterns, particularly unusually high rates of enrollments with data matching issues, with appropriate investigations and follow-up. CMS notes that an open DMI, by itself, does not indicate agent or broker noncompliance.These are CMS recommendations to insurers, not new federal regulatory requirements directly imposed on agents and brokers. Insurers may determine how to incorporate these measures into their existing oversight programs.

Objections to short notice

Health agent organizations told InsuranceNewsNet they don’t object to the guidance, but they object to agents being required to implement it on short notice, as open enrollment begins in less than two weeks.

The National Association of Benefits and Insurance Professionals said it supports efforts to prevent unauthorized enrollment, strengthen program integrity and protect consumers.

“These are shared priorities among CMS, insurers, and the agents and brokers who serve millions of Americans,” NABIP said in a recent social media post. “However, recommending a significant operational change like call recordings with less than two weeks before open enrollment leaves agents and brokers insufficient time to prepare and adapt their business practices while continuing to serve their clients effectively. Many are already navigating Medicare's annual enrollment period while preparing for marketplace open enrollment.”

NABIP noted that agents and brokers assist with 76% of HealthCare.gov plan selections “and play an essential role in helping consumers understand and access coverage. Their ability to serve consumers effectively must remain a priority.

"Agents and brokers are committed to doing business the right way and to serving consumers with integrity. We welcome improvements that protect consumers and strengthen the marketplace. Any recommended operational changes should come with enough notice for professionals to implement them responsibly, especially on the eve of open enrollment."

Health Agents for America president and CEO Ronnell Nolan said her organization also has no objection to recording ACA calls but objected to the short preparation time.

“Done properly, recording can protect both agents and consumers,” she said.

“Our concern is CMS asking carriers to pledge to require recordings with only 11 days to prepare. That is an unreasonable timeline and places another financial and operational burden on small independent agencies already navigating last-minute changes ahead of open enrollment.

Nolan said that calling the guidance a best practice “leaves critical questions unanswered.

“We still do not understand what CMS expects, whether carriers will treat it as mandatory, or how requirements may differ among carriers. Agents need clear written guidance and a realistic implementation period. Consumer protection deserves thoughtful planning, and the small businesses serving those consumers deserve time to get it right.”

The National Association of Insurance and Financial Advisors said in a statement that it
“appreciates the recognition by CMS of the central role agents and brokers play in the enrollment process and its efforts to combat fraud, improper enrollments, and unauthorized plan switches. NAIFA has consistently called for the identification and removal of bad actors.”

NAIFA noted that the CMS best practice recommendations are directed at insurers.

“Agents and brokers will need to watch closely how insurers incorporate these recommended best practices and follow the guidance of their appointed insurers. Agents and brokers will also need time to incorporate the recommended call recording changes, and NAIFA urges insurers to use caution when making major changes two weeks before open enrollment begins.”

NAIFA also said it seeks “an expeditious appeals process so that agents have recourse if they are improperly penalized.”

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Susan Rupe is editor in chief, magazine, for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at susan.rupe@innfeedback.com.