Here are the changes for health insurance shoppers
Consumers who buy Affordable Care Act health insurance are going to see changes both big and small as open enrollment for 2027 coverage kicks off.
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enrollment → buy → coverage
These include premium increases, possible additional identity checks, potential delays in working with a broker, and new limits on which immigrants can get subsidies.
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immigrants → include → subsidies
Shoppers need to plan accordingly.
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Shoppers → need → ?
Open enrollment starts Nov. 1 in most states.
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enrollment → start → states
Idaho, Connecticut, and Massachusetts started earlier, and some states have been allowing "window shopping" to check premium rates.
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shopping → start → rates
A continued decline in overall enrollment is expected, mainly because of the expiration of enhanced subsidies at the end of 2025.
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decline → expect → 2025
Policy experts say the end of those subsidies led millions to drop or lose coverage through the first few months of this year.
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end → say → year
But the Trump administration sees victory in the falling enrollment, crediting its various efforts to reduce fraud, including the August cancellation of policies covering 760,000 enrollees suspected to be improperly signed up.
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administration → see → enrollees
A small number of those enrollees have regained coverage.
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number → regain → coverage
Have your ID ready
One of the biggest changes for people shopping for their 2027 coverage will be increased scrutiny of both consumers and agents.
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One → have → consumers
The requirements are aimed at thwarting fraud or improper enrollments.
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requirements → aim → fraud
For consumers, it could slow the enrollment process.
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it → slow → process
The new rules, outlined by the Centers for Medicare & Medicaid Services, affect only consumers using agents or brokers to help them enroll through the federal marketplace, which serves 29 states.
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which → outline → states
They do not apply to state-based exchanges, which have their own rules and have in most cases been more successful at preventing fraudulent sign-ups.
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which → apply → ups
For starters, all consumers using an agent in the federal marketplace will need to get a one-time confirmation code or link to authorize a specific agent to enroll them or make changes on their behalf.
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consumers → use → behalf
It will be sent to consumers by text message, email, or an automated phone call from one of the private enrollment platforms used by their agent.
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It → send → agent
Returning consumers who have incorrect or outdated contact information will first need to call the federal marketplace themselves or submit an application online to update it.
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who → return → it
Additionally, consumers and policyholders deemed "high-risk" must verify their own identity before authorizing an agent.
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consumers → deem → agent
CMS defines as "high-risk" first-time applicants or those with existing coverage whose applications involve a change of state, as well as consumers working with a new or different agent or with a monthly premium payment of $30 or less.
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applications → define → less
Joshua Brooker, who oversees an insurance agency in Pennsylvania, said CMS appears to have selected people in those groups for greater scrutiny because "someone who is moving to a new state or switching brokers — that could be a broker trying to impersonate a consumer."
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that → oversee → consumer
The $30-a-month cutoff may be tied to concerns that plans with no or low monthly premiums are easier for bad agents to target for unauthorized enrollments because the policyholder may never get a bill.
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policyholder → tie → bill
Some rogue agents even pay the low monthly amount themselves and still make a profit from the commission, Brooker said.
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Brooker → pay → commission
The broad nature of the new rules, though, has Brooker concerned "that up to 1 in 5 consumers is going to have to do extra identity proofing" and may just give up and not get insured.
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consumers → have → proofing
Consumers designated high-risk must prove their identity through a CMS-approved third party such as credit company Experian, which generally asks questions only the consumer should be able to answer.
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consumer → designate → questions
People who fail this test may be asked to call Experian's help desk or submit their applications themselves by creating a healthcare.gov account, which requires them to upload identification such as a driver's license, a passport, immigration papers, or another form of ID.
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which → fail → ID
"Some people may have trouble not because they're not real, but because they don't have a credit file, or have moved, or have changed names," said Stacey Pogue, a senior research fellow at the Center on Health Insurance Reforms at Georgetown University.
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Pogue → have → University
She said the changes might "be an appropriate response by CMS that targets fraudulent enrollments but might also create extra hurdles.
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that → say → hurdles
There may be fewer brokers
CMS in September issued a rule that places a moratorium on brokers new to offering ACA coverage.
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that → issue → coverage
Agents not registered with the federal marketplace in 2026 will not be allowed to assist with enrollments for 2027 until February at the earliest, past the end of open enrollment season.
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Agents → register → season
CMS said it took this step because a disproportionate number of "significant compliance concerns" in 2026 came from newly registered agents or brokers.
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number → say → agents
Additionally, the agency has kicked out "hundreds of non-compliant agents and brokers" this year.
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agency → kick → agents
Jason Fine, who runs a brokerage in Florida, said he agrees with the concept behind these changes.
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he → run → changes
He has reported multiple times to CMS, for instance, that rogue agents have switched his clients' coverage without authorization, wanting the agency to take action against them.
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agency → report → them
But he said the updated rules also raise concerns.
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rules → say → concerns
"Everything they are doing in the long term makes sense," he said.
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he → do → sense
However, in the short term, "I don't know if they care about the chaos it will cause."
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it → know → chaos
That's because the moratorium will make it much harder for small brokers to help clients this year.
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brokers → make → clients
His agency and others often pare their staffing after open enrollment but hire again toward the end of the year.
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agency → pare → year
He was planning to add up to 10 agents to his core staff of about five but has been told by recruiters that he's unlikely to be able to find anyone who was registered for 2026 and is still available.
He suggested that the move unintentionally benefits larger call centers, some of which were doing much of the marketing that regulators feared led to unauthorized switching.
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regulators → plan → switching
Call centers often maintain larger staffs.
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centers → maintain → staffs
…and 32 more, not listed.
The Aporia
