Changes to Consent Requirements for Marketplace Consumers

The Centers for Medicare and Medicaid Services (CMS) have introduced new requirements that aim to protect consumer interests. The requirements, which help ensure greater transparency when working with health insurance agents and brokers, are part of the 2024 Notice of Benefit and Payment Parameters (NBPP).

These enhanced consumer protections were introduced in response to various complaints and disputes about who can act on an individual’s behalf. The rules apply to all enrollments by agents, brokers, and web-brokers, regardless of which platform they use.

Let’s explore some of the key points and what they mean for consumers:

Document Consent

Agents now need to document individual Marketplace customer consent for anyone under 65. This means they need to keep a record that an individual (or their authorized representative) has reviewed and confirmed their eligibility application information.

Agent Responsibility

The responsibility for documenting these requirements lies solely with the agent or broker. It’s not the responsibility of the insurance carrier. Documentation must be maintained for at least 10 years, and CMS may request documentation in response to consumer complaints. Agents must be prepared to provide documentation for monitoring, audit, and enforcement activities.

Flexibility in Documentation

CMS doesn’t mandate a specific template or method for documenting consumer consent. It's up to agents, brokers, and web-brokers to determine the best way for them to meet these new regulatory requirements. 

Agents need to receive the following information to document consent: 

• Individual’s name.

• The date when consent was given.

• Name(s) of the agent(s), broker(s), or agency to whom consent was given (including additional names if multiple agents or brokers within the same organization are involved).

Consent needs to acknowledge that the agents or brokers have informed consumers about their responsibilities and function in the Marketplace. It also needs to state that the consumer gives permission for agents to:

• Search for their application using approved Marketplace websites.

• Assist with completing eligibility applications.

• Provide help with plan selection and enrollment.

• Support customers with ongoing account and enrollment maintenance.

Why Are the Changes Necessary?

The changes have been introduced to help ensure customers have a secure and transparent process when working with insurance agents. By documenting your consent, CMS is helping to protect your information and reinforce your consumer rights. 

Need help?

If you have any questions about the changes, contact our local and experienced health insurance agents at Health Plan of NC. We can guide you through what information needs to be provided to meet the new requirements. And help you find the right plan on the Insurance Marketplace for your health needs and budget.