CMS kicks 760k enrollees off the Marketplace, issues new broker freeze

There’s no skirting around it. This is a big story for Marketplace agents. And so, we’ll borrow a line from the military and give you the Bottom Line Up Front (BLUF).

The Centers for Medicare and Medicaid Services (CMS)’s newest anti-fraud efforts means until further notice, agents without an active 2026 Marketplace agreement can’t certify until at least February 2027. This applies to FFE and SBE-FP Marketplaces, but state-based exchanges are unaffected.

In related moves, CMS canceled approximately 315,000 unauthorized enrollments covering over 760,000 individuals. An additional 419,000 enrollees are currently subject to review. 569 brokers received notices of intent to terminate Exchange Agreements, and 66 such terminations have already occurred.

Moreover, there will be additional items for agents and brokers to be aware of:

• Existing agents and brokers will have to complete a new round of identity proofing
• Social Security Numbers (SSNs) or immigration document numbers on all agent or broker-assisted non-newborn applications
• Electronic consumer authorization for any action an agent or broker takes on behalf of a consumer
• Banning the addition of agents and brokers to applications that consumers can complete on their own through Healthcare.gov

That’s a heck of a lot. Let’s dive in.

What’s driving the moratorium on new agent/broker registration for the Marketplace?

CMS found that new-to-the-Marketplace agents and brokers last year represent an outsized share of bad behavior for plan year 2026. Compared to those registered earlier, enrollments assisted by agents and brokers registered in 2026 were several times more likely to have missing SSNs, unresolved income verification issues, and unresolved citizenship or immigration verification issues.

New agents were also more likely to:

• Use SEPs not subject to verification
• Include Medicaid denial attestations
• Have enrollees dually enrolled in Medicaid/CHIP coverage

In total, these behaviors point to malicious agents and brokers creating fishy enrollments, pocketing a few months’ commissions on heavily subsidized plans, then disappearing into the night.

Why is CMS terminating enrollments and broker agreements?

Two sides of the same alleged fraud coin, really. On one hand, CMS is terminating enrollments that appear fraudulent. On the other hand, they’re terminating exchange agreements for those who appear to be making such enrollments.

Terminated coverage applications follow a pattern: they’re missing key income or SSN information, and their APTC and Marketplace eligibility are uncertain in the first place. But most importantly, the enrollee did not respond to at least two outreach attempts from carriers and/or the Marketplace.

The agents and brokers whose exchange agreements are slated for termination are associated with enrollments fitting that criteria.

How can agents and brokers complete the new identity proofing requirement?

If you haven’t logged into CMS systems for a while, there’s a new task waiting for you. You’ll have to prove your identity and link your CMS accounts to the identity-proofing system of your choice. Both require uploading some information, but the kinds of information each requires vary. And, it may come down to your preference on how you’d like your biometrics (typically, a face scan) handled. A quick chart to compare login.gov and id.me:

Both systems’ automated identity proofing processes can be completed in under 15 minutes. However, if you need to use a fallback method – say, because you don’t have a smartphone available – the login.gov fallback paths can take considerably longer due to that post-office visit and a snail mail verification code. On the other hand, if you need to use id.me’s fallback path, you’ll usually sit in a video call queue and be up and running on the same day.

What are the new hurdles to submitting Marketplace applications?

There are a few that you’ll have to pay attention to.

First, all agent-or-broker-assisted applications for non-newborns will require a valid Social Security Number or immigration document number. This, of course, is meant to prevent bad actors from fabricating clients out of thin air and collecting commissions on a contract that just happened to be fully subsidized by premium tax credits.

Second, consumers will only be able to add NPNs to applications and their updates on specific occasions. For example, NPN adds may not be allowed for a simple change of address; however, using a mid-year SEP may allow for an NPN addition.

Finally, at some point before this year’s Open Enrollment Period, CMS will require consumers to electronically authorize agents and brokers to work on their behalf on the Marketplace. Details on this requirement are few and far between, but we’ll keep you updated as we learn more.

What next steps make sense for agents and brokers in light of CMS’s announcement?

If you did not certify on the federal Marketplace for 2026, your next steps are painfully clear: you’re a sitting duck until CMS lifts the moratorium. That doesn’t mean your under-65 business is completely dead; you can still enroll off-Marketplace plans, ACA alternatives, and supplemental health products. Your Action Benefits team can help you with any and all of that.

If you did certify for 2026, you’ll have to complete the new identity-proofing process. And then, it’s business as usual. Well, as close to usual as this spring’s final rule allows, at least.