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CMS Statement On Unauthorized Plan Switches 2024

CMS Statement On Unauthorized Plan Switches 2024

The Centers for Medicare & Medicaid Services (CMS) is intensifying efforts to protect consumers in the HealthCare.gov Marketplaces amid rising incidents of unauthorized plan switches and enrollments orchestrated by unscrupulous agents and brokers.

In response to a surge of complaints, CMS has resolved over 97% of approximately 40,000 unauthorized plan switch cases reported in the first quarter of 2024. These cases involve instances where consumers were shifted into new plans without their consent, prompting CMS to reinstate affected enrollees into their original plans retroactively. Resolutions also ensure that all claims and cost-sharing obligations are properly accounted for to prevent adverse tax implications.

Similarly, CMS addressed nearly 88% of the approximately 50,000 unauthorized enrollment complaints during the same period. These cases involve consumers being enrolled in plans without their knowledge, resulting in prompt cancellations of unauthorized enrollments, reimbursement of any incurred costs, and updates to tax forms to mitigate financial repercussions.

The agency is committed to reducing resolution times, aiming to resolve unauthorized plan switch cases in less than 11 days and unauthorized enrollment cases in under 27 days by streamlining review processes.

CMS is also enhancing oversight of agents and brokers, swiftly terminating agreements with those found engaging in fraudulent or abusive practices. Measures include suspensions and potential civil monetary penalties to deter future misconduct. New technological safeguards will be implemented to prevent unauthorized activities, ensuring marketplace integrity.

Consumers impacted by unauthorized enrollments or plan switches are encouraged to contact the Marketplace Call Center for assistance at 1-800-318-2596 (TTY: 1-855-889-4325). CMS remains vigilant in safeguarding marketplace integrity and ensuring consumers have access to fair and transparent healthcare enrollment processes.

~ S. Green

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