CMS Is Targeting Unauthorized Health Insurance Enrollments-Here's What Consumers Should Check

(MENAFN- Saving Advice) Imagine going to use your health insurance and discovering that the plan you thought you had isn't the plan showing in the system or learning that someone enrolled you in Marketplace coverage you never requested. That isn't merely hypothetical: the Centers for Medicare & Medicaid Services received more than 183,000 complaints of unauthorized enrollments and more than 90,000 complaints of unauthorized plan switches from January through August 2024. CMS responded with tighter controls designed to stop agents and brokers from changing consumers' coverage without their involvement. The agency says complaints involving unauthorized enrollments and plan switches subsequently fell 31% between the first 10 months of 2024 and the same period in 2025, although more than 124,000 complaints were still reported during that 2025 period. An occasional Marketplace health insurance check can help you catch a plan, agent, premium, or household detail that doesn't look right. Here's everything you need to know.

Editor's Note: This article concerns Affordable Care Act Marketplace coverage, not Medicare plan enrollment.

CMS Has Added More Protections for 2027

CMS says the problem has improved but hasn't disappeared. The agency reported that complaints involving unauthorized enrollments and plan switches fell 31%, from 180,750 during the first 10 months of 2024 to 124,533 during the same period in 2025, following system and enforcement changes. CMS is also introducing another safeguard ahead of 2027 Open Enrollment: certain online enrollment partners will be required to systematically verify consumers' identities and confirm that agents, brokers, or web-brokers are actually authorized to act on their behalf.

That's significant because CMS says Enhanced Direct Enrollment platforms accounted for approximately 76% of active plan selections during 2026 Open Enrollment. The additional protection is intended to make it harder for someone to use a consumer's information to submit an application or enrollment without that person's knowledge.

Make Sure You're Enrolled in the Plan You Actually Chose

Start with the most basic detail: the exact name of your current health plan. CMS documented cases in which consumers reported being switched from one Federally-facilitated Marketplace plan to another without giving permission, a problem the agency refers to as an unauthorized plan switch.

In July 2024, CMS changed Marketplace systems so an agent or broker generally couldn't change an enrollment unless that person was already associated with the consumer's policy. Someone wanting to use a new agent generally must now take additional steps involving the consumer, such as completing a three-way call with the Marketplace Call Center or having the consumer make the change through an approved pathway.

During your Marketplace health insurance check, compare the plan name in your account with your insurance card and the coverage you remember selecting.

Check Your Premium and Financial Assistance

A plan can look familiar while another important number has changed: what you're expected to pay each month. Marketplace premium tax credits are based partly on household and income information, so consumers should verify that their application still accurately reflects their circumstances. You should promptly report relevant changes involving expected income, household members, job-based coverage, Medicaid, Medicare, marriage, divorce, pregnancy, and other circumstances that can affect eligibility or savings.

An incorrect Marketplace application can potentially affect the financial assistance you're receiving and create unpleasant surprises later. Compare your current premium and eligibility information with what you expect rather than simply letting automatic payments continue without reviewing them.

Look at the Agent or Broker Connected to Your Coverage

Agents and brokers legitimately help millions of people compare plans and complete Marketplace enrollments, so having one associated with your policy isn't inherently suspicious. The warning sign is an agent or broker you don't recognize or don't remember authorizing to help you. CMS said unauthorized changes could provide a financial incentive because agents and brokers may receive commissions connected with enrollments, and its July 2024 system protections also restricted unauthorized changes to commission information.

After those protections took effect, CMS reported that changes to agent or broker commission information fell nearly 90%. If your Marketplace health insurance check turns up an unfamiliar person connected with your coverage, don't assume that relationship is legitimate simply because the name appears in the system.

Verify Your Household and Contact Information

Next, check the information underlying the policy rather than looking only at the insurance company's name. Your Marketplace application can contain details involving household members, expected income, address, tax filing status, Social Security information, and other eligibility-related information. Consumers can update an application online by signing into their account, selecting the appropriate application, and using the option to report a life change.

Keeping those details accurate matters because they can influence both eligibility and the amount of financial assistance you receive. If something has changed that you didn't authorize (or information appears that you never supplied), contact the Marketplace rather than simply correcting it and forgetting about the unexplained change.

Don't Trust an Enrollment Offer Just Because It Sounds Official

HealthCare currently warns consumers not to share personal information with someone offering cash, gifts, or other perks because the information could potentially be used without their consent. That matters because enrolling someone in health coverage requires personal details that can become valuable in the wrong hands. Be cautious with unsolicited calls, social-media advertisements, websites, or representatives promising unusually generous benefits in exchange for your Marketplace or personal information.

If you want enrollment assistance, you can find trained assisters as well as agents and brokers who can help consumers apply and select coverage. Starting from the official Marketplace rather than clicking an unfamiliar advertisement gives you a safer path to legitimate assistance.

Pay Attention to Unexpected Insurance Mail and Emails

Don't automatically throw away an insurance-company letter because you don't recognize the company. That unfamiliar name may be precisely why the letter deserves attention. An unexpected enrollment confirmation, insurance card, cancellation notice, premium bill, or message about a coverage change can indicate that something happened to your policy.

Likewise, losing access to a doctor or pharmacy that previously accepted your plan may warrant checking whether the plan itself changed. CMS reported that after its July 2024 protections were implemented, consumer casework involving unauthorized plan changes dropped about 30%, while overall plan changes associated with agents or brokers fell nearly 70%. Those improvements are encouraging, but they don't eliminate the value of doing your own Marketplace health insurance check whenever something about your coverage suddenly seems different.

Know Where to Report a Change You Didn't Authorize

If you discover an unfamiliar enrollment or plan change, don't try to solve the problem through a suspicious caller or website that contacted you in the first place. CMS directs consumers who believe they've experienced unauthorized agent or broker activity to the Health Insurance Marketplace Call Center at 1-800-318-2596, with TTY service available at 1-855-889-4325.

The Marketplace Call Center can help with coverage questions and enrollment problems, and it's available 24 hours a day, seven days a week except holidays. Keep copies or screenshots of unexpected notices and write down when you discovered the problem, what changed, and the names of any agents or companies involved. That documentation can make it easier to explain why the current enrollment doesn't match what you authorized.

Do This Before November 1

You don't need to wait until something goes wrong to review your Marketplace account. With 2027 Open Enrollment beginning November 1, consider logging in beforehand and taking a screenshot or writing down your current plan name, premium, household information, financial assistance, and any agent or broker associated with the enrollment. That gives you a simple before-and-after record to compare with any changes made during Open

HealthCare says November 1 is the first day consumers can enroll, renew, or change Marketplace plans for 2027, while December 15 is the deadline for coverage beginning January 1. Treat that pre-enrollment review the same way you might photograph the odometer before handing your car to a repair shop: you're creating a record of where things stood before changes begin.

Your Insurance Deserves the Same Attention as Your Bank Account

Most people would investigate immediately if an unfamiliar withdrawal appeared on a checking account, and health insurance deserves a similar level of attention. CMS's experience with hundreds of thousands of complaints demonstrates that unauthorized Marketplace enrollments and plan switches have been a real consumer-protection problem, even though system changes have significantly reduced suspicious activity. A periodic check doesn't need to be complicated: verify your plan, premium, financial assistance, household information, contact details, and any agent or broker associated with your enrollment. Be particularly alert before the next Open Enrollment period, which begins November 1 for 2027 coverage.

Have you ever logged into your Marketplace account and found a plan, agent, premium, or other detail you didn't recognize? Share your experience in the comments.

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