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CMS tightens ACA broker access rules ahead of fall open enrollment
The agency says CMS will block broker-submitted ACA applications starting this summer if they do not include an enrollee Social Security number, and it will require carriers to report unverified policies after 60 days.
Federal regulators are tightening how brokers access and submit Affordable Care Act applications before the fall open enrollment period, with new identity proofing and consent documentation standards designed to reduce suspected fraud, according to reporting by Insurance Business.
The rules come after ACA enrollment fell by nearly three million to about 19.2 million this year, as described in an HHS report released in June 2026 and reviewed by KFF Health News. The administration attributed the decline to a fraud crackdown, citing 5.6 million people fraudulently enrolled in 2025, and saying it removed 2.9 million, though health policy experts dispute that framing and point to rising costs, including a 58% increase in average monthly premiums to $178, and a 37% increase in deductibles to nearly $3,800 per year.
Centers for Medicare & Medicaid Services plans to require more identity proofing when brokers enroll consumers before open enrollment this fall, including limiting broker access to accounts until the broker has been authorized by the consumer to work on their behalf. Starting this summer, CMS will block ACA applications submitted by brokers that lack a Social Security number for the enrollee, and each flagged account is described as having been submitted by a sales broker who used a zero premium to enroll consumers without Social Security or immigration documentation numbers.
Insurers have been directed to contact enrollees to verify their sign up, and after 60 days carriers must report unverified policies to CMS for cancellation. The process is detailed in emails sent to carriers in June, and the consent documentation change follows a broader pattern of CMS tightening broker oversight in prior rule cycles, including a May 2026 rule focused on broker marketing practices and standardized documentation for consumer consent and eligibility reviews.