Health Insurance Enrollment: New Rules Target Fraud

Open enrollment for 2027 health coverage begins on November 1 in most states.

Shoppers for Affordable Care Act plans face a series of new administrative hurdles designed to reduce fraud. The Centers for Medicare and Medicaid Services has implemented rules that require consumers using agents or brokers in the federal marketplace to undergo additional identity verification. These changes apply to the 29 states using the federal exchange but do not affect state-based markets. The administration views the resulting drop in enrollment numbers as a success in combating improper signups, including the cancellation of policies for 760,000 people in August.

The new protocol requires all consumers using an agent to receive a one-time confirmation code via text, email, or phone call. This step authorizes the agent to act on their behalf. Consumers with outdated contact information must update their details directly on the federal marketplace website before proceeding. Additionally, CMS designates certain applicants as high-risk, requiring them to verify their identity through a third-party service like Experian before authorizing an agent. This category includes first-time applicants, those changing states, and anyone paying a monthly premium of $30 or less. Joshua Brooker, an insurance agency owner in Pennsylvania, noted that these groups are targets because bad actors often impersonate consumers in these scenarios. He warned that up to one in five consumers may face this extra proofing, which could cause some to abandon the process entirely.

A separate rule issued in September places a moratorium on brokers who are new to the marketplace. Agents not registered in 2026 cannot assist with 2027 enrollments until at least February. This timing falls after the open enrollment season ends. CMS stated that a disproportionate number of compliance issues in 2026 came from newly registered agents. Jason Fine, a Florida brokerage owner, said the rule makes it difficult to hire experienced staff during the peak season. He estimated that his agency, which usually has about five staff members, planned to add ten new agents but may struggle to find candidates who meet the registration requirement. He argued that the rule benefits large call centers that maintain year-round staff, while small agencies suffer. Two agent groups have filed lawsuits against the administration, with one claiming the rule unfairly impacts 19,000 potential new salespeople.

Premium costs remain a central concern for shoppers. The expiration of enhanced subsidies at the end of 2025 led to higher out-of-pocket costs for many. While standard subsidies remain, they are less generous. The average premium increase was 26% last year. For the upcoming year, insurers are projecting a 15% increase, which is lower than the previous year but still double digits. Subsidies are income-based and phase out for households earning more than four times the federal poverty line. In this enrollment period, that threshold is $63,840 for a single person and $109,280 for a family of three. Louise Norris, a health policy analyst, noted that overall affordability will likely remain stable for most, but consumers should compare plans rather than letting them auto-renew. The out-of-pocket maximum, which limits annual spending, will rise by 13% to $12,000 for individuals and $24,000 for families in 2027.

Immigration status also affects subsidy eligibility. The One Big Beautiful Bill Act removed subsidy access for many lawfully present immigrants, including those with H-1B visas, refugee status, and pending green-card applications. Only three groups remain eligible: green-card holders, specific Cuban and Haitian immigrants, and citizens of Micronesia, the Marshall Islands, or Palau. Stacey Pogue, a research fellow at Georgetown University, advised consumers not to delay appointments. She warned that fewer available brokers could lead to filled schedules. She emphasized that the new rules aim to target fraud but may create unnecessary hurdles for legitimate applicants who lack extensive credit histories or have recent name changes.