CMS tightens identity rules and pauses new broker registrations for 2027 ACA enrollment

The Centers for Medicare & Medicaid Services has implemented stricter identity verification protocols and a temporary pause on new broker registrations for the 2027 Affordable Care Act open enrollment period. These measures, which take effect as enrollment begins November 1 in most states, aim to reduce fraud and improper sign-ups while potentially slowing the application process for consumers using agents in the 29 states served by the federal marketplace.

The administration cites the recent drop in overall enrollment as evidence that its anti-fraud efforts are working. In August, officials canceled policies for 760,000 enrollees suspected of being improperly registered. While most of those individuals have lost coverage, a small number have since regained it. The decline follows the expiration of enhanced subsidies at the end of 2025, which policy experts say caused millions to drop coverage in the early months of this year.

New rules require consumers working with agents to receive a one-time confirmation code via text, email, or phone call to authorize representation. This step applies to all federal marketplace users, not those on state-based exchanges. Additionally, applicants designated as high-risk must verify their identity through a third-party service like Experian before an agent can act on their behalf. High-risk status includes first-time applicants, those changing states, or those with monthly premiums of $30 or less.

Joshua Brooker, an insurance agency owner in Pennsylvania, noted that the $30 threshold likely targets low-cost plans where policyholders might not notice unauthorized billing. He warned that up to one in five consumers may face these extra identity checks, creating potential barriers for those without established credit files. Stacey Pogue, a senior research fellow at Georgetown University, agreed that while the rules target fraud, they may create unnecessary hurdles for legitimate applicants.

CMS also issued a September rule barring brokers newly registered in 2026 from assisting with 2027 enrollments until February. The agency stated that a disproportionate number of compliance concerns this year came from new agents. Jason Fine, a Florida brokerage owner, said the move helps larger call centers maintain stable staff while small brokers struggle to find eligible agents. His firm planned to hire ten new agents but found it difficult to locate candidates registered for 2026.

Two industry groups have challenged the broker moratorium in court. The National Association of Benefits and Insurance Professionals filed a lawsuit on October 15, and Health Agents for America filed for a temporary restraining order on October 21. Ronnell Nolan, president of the latter group, argued that the rule unfairly targets 19,000 agents who have completed training and paid fees to enter the market.

Premium costs for 2027 are expected to rise by approximately 15%, following a 26% increase last year. Subsidies remain available for households earning below four times the federal poverty rate, which is $63,840 for a single person this year. However, the One Big Beautiful Bill Act strips subsidy eligibility from many lawfully present immigrants, including H-1B visa holders and refugees. Only green-card holders and citizens of specific Pacific Island nations retain full eligibility. Louise Norris, a health policy analyst, advised consumers to compare plans carefully rather than allowing policies to auto-renew, as out-of-pocket maximums will rise to $12,000 for individuals and $24,000 for families.