Key Marketplace System Updates for 2025 Open Enrollment

AOBG Agents: Key Marketplace System Updates for 2025 Open Enrollment

As we gear up for the 2025 Open Enrollment Period, it's essential to understand new changes from CMS that impact Marketplace enrollments. These updates are designed to protect agents, brokers, and consumers from unauthorized activities and improve enrollment security. Here’s a breakdown of the key system changes and how they may affect your workflow.

1. Blocking Unauthorized NPN Switching

CMS has implemented a new system change to block unauthorized changes to consumers' Marketplace enrollments. Agents or brokers who aren’t already associated with a consumer’s existing enrollment are now unable to make updates without taking specific steps:

• If you're not currently linked to a consumer’s enrollment, you must either:
  • Conduct a three-way call with the consumer and the Marketplace Call Center to initiate the change.
  • Direct the consumer to submit the update themselves via HealthCare.gov or through an approved Classic Direct Enrollment (DE) or Enhanced Direct Enrollment (EDE) platform.

This measure ensures that only agents with an established relationship with the consumer can make enrollment changes, protecting both parties from potential fraud or unauthorized modifications.

2. Social Security Number (SSN) Verification Requirement

Starting in October 2024, applications submitted through agents or brokers must include a verifiable SSN for all individuals over 90 days old seeking coverage. This requirement applies to the Classic DE and EDE pathways and aims to bolster the accuracy and legitimacy of submitted applications.

Exceptions for Noncitizens:

• Noncitizens who qualify for Marketplace coverage but lack SSNs are still eligible if they meet other requirements. Beginning in December 2024, CMS will enable agents to submit applications for these individuals if they can provide verifiable immigration documentation.
• Consumers without an SSN can still apply for coverage directly via HealthCare.gov, through the Classic DE/EDE consumer pathways, or by calling the Marketplace Call Center.

These changes help ensure that only verified individuals can access coverage through the Marketplace, reducing the risk of fraudulent enrollments and protecting consumer information.

Need Support?

If you have questions about these updates or need assistance with the new requirements, reach out to the Agent/Broker Email Help Desk at [email protected].

By staying informed and prepared, you can effectively guide consumers through a secure enrollment process and provide the exceptional service they depend on. Let’s make this Open Enrollment a success by adapting to these enhancements and safeguarding the trust consumers place in our hands.

CMS Statement on System Changes to Stop Unauthorized Agent and Broker Marketplace Activity | CMS

The Centers for Medicare & Medicaid Services (CMS) is committed to protecting consumers from bad actors and ensuring the program integrity of the Federally-facilitated Marketplace (FFM). That’s why CMS is taking additional action to address increases in unauthorized changes in consumers’ enrollments by agents and brokers. Starting on July 19, 2024, CMS will block an agent or broker from making changes to a consumer’s FFM enrollment unless the agent is already associated with the consumer’s enrollment.

CMS.gov