Federal regulators are changing how brokers access and submit Affordable Care Act (ACA) applications before this fall's open enrollment. Agents who have not tightened their documentation practices face rejected applications, flagged accounts, and scrutiny of their National Producer Numbers (NPN).
The rule changes follow a sharp drop in ACA enrollment and a federal push to remove fraudulently enrolled policyholders. Enrollment fell nearly three million to about 19.2 million this year, according to an HHS report released in June 2026 and reviewed by KFF Health News.
The administration's fraud crackdown is the stated reason for the decline. The HHS report asserts 5.6 million people were fraudulently enrolled in ACA plans in 2025. The Trump administration said it removed 2.9 million of them.
Health policy experts dispute that framing. They attribute the drop to a 58% rise in average monthly premiums to $178, according to KFF. Deductibles climbed 37% to nearly $3,800 a year.
Centers for Medicare & Medicaid Services (CMS) plans to require more identity-proofing when brokers enroll consumers before open enrollment this fall. The agency will also limit a broker's access to accounts until that broker "has been authorized by the consumer to work on their behalf," CMS spokesperson Christopher Krepich told KFF Health News.
Starting this summer, CMS will block ACA applications submitted by brokers that lack a Social Security number for the enrollee. Each flagged account will have used a sales broker to enroll, carry a zero premium, and lack a Social Security or immigration documentation number.
Insurers have been directed to contact those enrollees to verify their sign-up. After 60 days, carriers must report unverified policies to CMS for cancellation. The process is spelled out in emails sent to insurance carriers in June and obtained by KFF Health News.
The consent documentation requirement fits a pattern of CMS tightening broker oversight across multiple rule cycles. A May 2026 rule added clearer prohibitions on broker marketing practices and standardized documentation requirements for consumer consent and eligibility reviews.
The fraud the administration is targeting involves commission-seeking agents who enrolled consumers without their knowledge. Those agents collected commissions while the enrollees, often unaware they had coverage, filed no claims. The HHS report flags zero-claim enrollees and consumers shifted to zero-premium plans as patterns consistent with unauthorized broker activity.
The enforcement consequences for that conduct are documented. AssuredPartners of South Florida agreed in April 2026 to plead guilty and pay more than $160 million to resolve an ACA enrollment fraud scheme.
Employees had submitted false applications to collect maximum subsidies. The DOJ's Health Care Fraud Unit charged 194 individuals with ACA-related crimes in 2025, with intended losses exceeding $15 billion.
Legitimate brokers whose NPNs are associated with flagged accounts face the same scrutiny, regardless of intent. Florida insurance agent Jason Fine told KFF Health News the administration needs to focus enforcement on proven bad actors: "I would not immediately assume that a person who went from a silver plan to a bronze plan, that it's fraud."
Fine and other agents have long pushed for multifactor authentication on the federal marketplace, healthcare.gov. Ronnell Nolan, who leads Health Agents for America, said legislation introduced in June by Rep. Glenn Grothman (R-Wis.) to require it might "encourage CMS to do it themselves." CMS has not added two-factor authentication to the federal marketplace under either the Biden or Trump administration.
For brokers writing ACA business, the compliance baseline has shifted. Document consumer consent before submission, confirm Social Security numbers are on file, and verify income information ahead of every application this enrollment season.
