The new regulations, once finalized, will strengthen eligibility verification, prohibit misleading marketing practices, and track improper payments.
The Centers for Medicare and Medicaid Services has unveiled new regulations to strengthen the integrity of the Affordable Care Act insurance exchanges and promote innovation.
The Affordable Care Act is former President Barack Obama’s health care law, known as Obamacare. The new federal rule, released for comment on Feb. 9, will lower the cost of health care, according to Health and Human Services Secretary Robert F. Kennedy Jr.
“At President [Donald] Trump’s direction, [this agency] is driving down costs and rooting out fraud across our health insurance programs,” Kennedy said in a statement, predicting that the policy changes overall will reduce premiums and increase consumer choice.
Eligibility Verification
New anti-fraud regulations will require stronger enforcement of eligibility and income verification, correcting a situation that some observers say allowed unscrupulous insurance brokers to sign up millions of people for the program without their knowledge, particularly in plans with no premiums.
AHIP, the trade association for health insurance companies, has disputed that claim. However, 24 states had more enrollees in Obamacare zero premium plans in 2024 than they had qualifying residents, according to data from the think tank Paragon Health Institute.
The new regulations, once finalized, will require agents and brokers to use federally-approved forms for verifying enrollee eligibility and to obtain their consent for enrollment.
The regulations also make it clear what action a consumer must take to review and affirm his personal and eligibility information and to signify his consent.
The rule would clarify which individuals qualify for Obamacare subsidies as “eligible noncitizens” and would deny subsidies to those who are ineligible for Medicaid because of their immigration status.
Marketing Practices
A second program change prohibits certain marketing practices for agents and brokers who help customers sign up for Obamacare through the federal and state marketplaces.
Providing cash, cash equivalents, or monetary rebates to influence customers to enroll would be prohibited.
Falsely suggesting that customers would qualify for a zero premium plan and misleading customers about enrollment deadlines would also be prohibited.
“This proposal would ensure consumers are provided accurate information about the Exchange prior to enrollment, maintain the integrity of the exchanges, and foster trust between consumers and agents, brokers, and web-brokers,” the Centers for Medicare and Medicaid Services stated.
