America's Benefit Specialist November 2023

HOW AGENTS AND BROKERS CAN PROTECT THEMSELVES AND THEIR MARKETPLACE CLIENTS

From CMS

In recent years with expanded tax credits and more compet itive markets, the Health Insurance Marketplace® has seen a substantial increase in the number of consumers enrolling in Marketplace coverage and the number of agents and bro kers registering to sell Marketplace plans. Marketplace-registered agents and brokers have played an important role in the growth of the Marketplace, and the vast majority of agents and brokers are focused on serving their clients to help them get access to the health insur ance coverage and essential care they need. However, even a small number of potential bad actors can cause signifi cant harm to the Marketplace program. When agents and brokers act without proper authorization from consumers, this puts people at risk of losing coverage, financial assis tance, preferred doctors and critical prescriptions, as well as paying tax penalties. With these concerns in mind, the Centers for Medicare & Medicaid Services has adopted new regulations that require agents and brokers who assist with or facilitate enrollment in Marketplace 1 coverage to document that they have consent

from consumers or their authorized representatives before assisting them with Marketplace enrollment or applying for advance payments of the premium tax credit (APTC) or cost-sharing reductions (CSRs). The new regulations also require that agents and brokers document that consum ers or their authorized representatives have reviewed and confirmed the accuracy of all eligibility information on the Marketplace eligibility application before it is submitted. While obtaining consumer consent has always been a requirement in the Marketplace, this Open Enrollment Pe riod, which runs from November 1 through January 15, will be the first OEP that these new documentation regulations are in effect. Agents and brokers may document consumer consent and Marketplace eligibility application review in any manner that best works for them, as long as their documentation meets all regulatory requirements. Some formats that may be acceptable include electronically signed forms, an image of a physical form with a wet signature from the consumer, emails or text messages from the consumer to the approved

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