GAO: Federal Marketplace Controls Left Consumers Vulnerable to Plan Changes
Safeguards on the federal Affordable Care Act Marketplace did not reliably verify that consumers authorized agents and brokers to enroll them or change their plans, the Government Accountability Office said in a report publicly released July 13, 2026.
The weaknesses could leave people facing unexpected premiums, altered tax credits, different provider networks, prescription disruptions or gaps in coverage. The findings are drawing attention as the Centers for Medicare & Medicaid Services prepares for Plan Year 2027 registration and training.
What GAO found
CMS requires Marketplace agents and brokers to be licensed, registered and authorized by consumers before helping with enrollment or plan changes. But GAO identified three major weaknesses in the federal Marketplace’s controls.
First, CMS’s procedures for verifying consumer consent were not strong enough. Although the agency introduced additional consent procedures in 2024, GAO found that the procedures were not always used and that CMS took limited steps to confirm the consumer’s identity.
Second, access to consumer records was not limited to the agent or broker already associated with the enrollment. Third, consumers were not notified about every action an agent or broker took on their Marketplace account.
GAO said at least 160,000 federal Marketplace applications in Plan Year 2024 had likely unauthorized changes. The estimate does not mean every application represented a proven fraud case.
GAO also reported that complaints tied to confirmed unauthorized enrollments and plan switches grew more than fourfold from 2023 through 2025. A comparison of the GAO figures cited in independent reporting puts the combined total at 66,548 complaints in 2023 and 299,604 in 2025.
Why an unauthorized change matters
A plan change can affect more than the name of an insurer. It may alter a household’s monthly premium, advance premium tax credit, deductible, provider network or prescription coverage. Someone who does not notice the change could seek care under the wrong plan or discover a coverage problem when a bill arrives.
GAO said it reviewed the federal Marketplace maintained by CMS and compared its safeguards with controls in three selected state-based exchanges: California, Georgia and New Mexico. Those exchanges used additional measures, including one-time passcodes to verify consumer consent for some agent and broker actions.
CMS says complaints and case resolution have improved
CMS has said it is investigating unauthorized enrollments and plan switches and has improved the speed of case resolution. In a January 28, 2026 fact sheet, the agency said the average time to resolve an unauthorized plan-switch case in an issuer’s system had fallen to approximately seven days from receipt of a complaint, while unauthorized-enrollment cases averaged about five days.
CMS also reported a 31% decrease in complaints of unauthorized enrollments and plan switches from January through October 2024 to the same period in 2025, from 180,750 to 124,533. CMS cautions that the methodology used for that comparison differs from the methodology in an earlier fact sheet, so the figures are not directly comparable to every other complaint series.
Those operational improvements do not change GAO’s conclusion that weaknesses remain in consent verification, account access and consumer notifications.
CMS’s current agent and broker registration page says Plan Year 2026 registration and training is closed while the agency prepares for Plan Year 2027 registration and training. The page does not announce final changes to Marketplace controls.
What could change next
GAO recommended stronger safeguards, including possible one-time passcodes, tighter limits on access to consumer records and fuller notifications of account activity. The Department of Health and Human Services concurred with both recommendations.
CMS told GAO it was exploring possible safeguards for the Plan Year 2027 open-enrollment period, but the agency had not made final decisions. The report is not a new rule or a final CMS enforcement action.
What Marketplace consumers can do
People who use an agent or broker should review Marketplace notices and account information for unexpected changes. Check the plan name, premium, tax-credit amount, provider network, prescriptions and coverage dates. Ask what permission the agent is requesting and retain confirmation records.
Anyone who believes a federal Marketplace enrollment or plan switch occurred without consent can contact the Marketplace Call Center at 1-800-318-2596. The key issue to watch is whether CMS adopts stronger verification, account-access and notification controls before Plan Year 2027 enrollment.
Sources
- U.S. Government Accountability Office report on Marketplace controls
- CMS program-integrity and consumer-protection fact sheet
- Fox Business report on the GAO findings
Look for updates to this story
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