In the past year, we have seen new regulations that address insurance agents and insurance brokers behavior in the ACA Marketplace, and the Centers for Medicare and Medicaid Services (CMS) is proposing more agent-centered rules for the 2026 plan year.
In a document released Oct. 4, the CMS outlined new measures to further guard consumers and deal with agents who do not follow CMS ACA regulations. Already the insurance industry has seen big changes that focus on making it difficult for agents to make unauthorized switches to ACA healthcare plans. These changes to ACA rules have led to three-way calls and additional digital forms to authorize changes to insurance plans.
Insurance Agents Can Be Suspended
The 2026 proposed ACA rules will give the CMS the ability to suspend insurance agents. The CMS is seeking to expand its authority so it can “suspend an insurance agent or broker’s ability to transact information with the Marketplace itself if we discover circumstances that pose an unacceptable risk to the accuracy of Marketplace eligibility determinations, operations, applicants, and or enrollees.”
The CMS believes this ability to suspend insurance agents will act as a deterrent to bad behavior and curtail activities that may harm consumers.
Model Consent Form Changes
The CMS is also proposing new ACA rules surrounding consumer consent. This will come as an update to the model consent form. A new and expanded form is expected to go further to make sure a consumer has reviewed and confirmed the accuracy of an eligibility application.
The new model consent form, if approved, will include scripts that agents and brokers will use to document compliance and consumer eligibility and must include audio recordings. Audio recordings are required now when insurance agents and brokers seek verbal consent for health plan changes. The CMS says these changes will add transparency and accountability to the process.
Some insurance agents and brokers already use their own scripts to ensure compliance and thoroughness when working with consumers so this change should not be a large hurdle if implemented.
Comment Period Has Ended
The comment period regarding these proposed ACA rules changes has closed. It ended Nov. 12. The new proposed ACA rules affecting brokers were part of the 2026 Payment Notice regulations put out by the CMS.
The new ACA rules could also impact Silver Plans, premium payment thresholds, and other ACA regulations. We will have to wait until next year to see if all or some of the new regulations become law.
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