What Changes for ACA Brokers on November 1?

For 2027 coverage, every agent- or broker-assisted application submitted through an Enhanced Direct Enrollment (EDE) platform requires the consumer to authorize that specific agent, usually with a one-time passcode or confirmation link, and “high-risk” applications also require the consumer to pass identity proofing first. According to the CMS EDE identity proofing and authorization FAQs, agents are blocked from moving forward with an application or enrollment until the authorization is complete. EDE partners had to put these changes into production by October 12, 2026.

Open Enrollment for 2027 coverage starts November 1. December 15 is the deadline for January 1 coverage, and January 15 is the final deadline, according to HealthCare.gov. Three other developments shape the season:

• Call recording. In an October 19 memo, CMS recommended that insurers have their appointed agents record consumer calls involving plan comparison, enrollment, sales and marketing, starting this Open Enrollment.
• Monthly data-matching reviews. The same memo tells insurers to review agents with high rates of enrollments tied to open data-matching issues, generally each month, and to act within about a month, including suspending commissions or ending appointments when appropriate.
• A 2028 verification proposal. On October 23, CMS proposed rule CMS-9873-P, which would require eligibility verification before subsidies start, beginning with 2028 coverage.

These rules apply to the Federally-facilitated Exchange and State-based Exchanges on the Federal Platform, which use HealthCare.gov. States that run their own exchanges and platforms set their own procedures, so check each one.

How Consumer Authorization Works

The CMS FAQs and the Marketplace Enrollment Pathways tip sheet lay out the mechanics:

• Every application, every year. All agent-assisted EDE applications require authorization regardless of risk level. Authorizations must be gathered every plan year, even for consumers who already have an account on that platform.
• Single-use and short-lived. Passcodes and confirmation links are single-use and expire within 15 minutes of being generated.
• Limited resends. EDE partners may not send more than three notifications within 24 hours for the same agent and application.
• Lasts the plan year. Once a consumer authorizes you, the authorization lasts for the plan year, or until the consumer authorizes a different agent.
• The consumer controls contact information. Agents cannot update consumer contact information, so the code goes to the consumer, not to you.
• ID proofing can carry over. If a consumer has an account on a given EDE platform with ID proofing tied to it, that proofing can stay valid. Without an account, ID proofing must be redone each coverage year.

Low-Risk vs. High-Risk: Who Needs ID Proofing

CMS uses three criteria to define a high-risk application. Meeting any one of them triggers identity proofing before authorization, according to the CMS FAQs:

Identity proofing uses the CMS-provided Experian service or a CMS-approved third-party service that meets federal identity assurance standards. Consumers who fail can contact the Experian help desk or use another approved service, if the platform offers one.

Six Enrollment Scenarios

These hypothetical examples show how the new rules play out. Platform workflows vary, so follow your EDE partner’s steps.

1. The $0-premium renewal

Rosa, a returning client, pays $0 a month after tax credits. Because her net premium is $30 or less, her application is high-risk. She must pass ID proofing and then enter your passcode before you can update her 2027 application. Plan 10 to 15 extra minutes, and make sure she has her phone or email handy.

2. The client who is driving

Marcus calls from his truck and asks you to “just handle it.” You send the passcode, and he can’t check his phone for 20 minutes. The code expires after 15. Reschedule for a time when he can respond right away, and remember that only three notifications can be sent in 24 hours.

3. The client switching agents

Linda worked with another agent in 2026 and wants you for 2027. Because she is working with a new agent, her application is high-risk regardless of premium. She will need ID proofing even though she is not new to the Marketplace.

4. The client who moved

David moved from Georgia to Texas. An application for coverage in a different state counts as a new application, so it is high-risk. Confirm his new address and coverage state, and prepare him for the ID check.

5. The client who fails the Experian quiz

Ana has a thin credit file and can’t answer the Experian questions. Your options are to have her call the Experian help desk or use another CMS-approved ID service on your platform. If she ends up enrolling herself on HealthCare.gov, you may not be able to add your NPN. ID-proofing clients like Ana early, before the November rush, is the best defense.

6. The low-risk returning client

James stays with you, pays $85 a month after tax credits, and has no changes. His application is low-risk, so he only needs to enter the one-time passcode. Two minutes, and you’re done.

CMS’s New Call Recording Guidance

In its October 19 best practices memo, CMS said it expects agents, as a best practice, to record Marketplace calls covering plan comparison, enrollment and sales and marketing. CMS framed this as a recommendation that insurers direct their appointed agents to follow, modeled on the Medicare Advantage and Part D call recording requirements.

CMS also recommends that agents keep recordings in a form they can provide to the insurer or CMS on request, follow federal privacy and security standards, and comply with federal and state consent laws. Some states, such as Florida and Pennsylvania, generally require all parties to consent to a recording, so announce the recording at the start of every call.

Recordings can also help you show compliance with existing rules requiring agents to document consumer consent and the consumer’s review of their application. CMS’s consent and application review FAQs say that documentation must be kept for at least 10 years and provided to CMS on request.

Data-Matching Issues Now Put Commissions at Risk

CMS told insurers that, starting with this Open Enrollment, it will send them a recurring file listing plan year 2027 policies with open data-matching issues (DMIs) and the agent NPN on each. The memo notes that an open DMI on its own does not mean an agent did anything wrong. But CMS has seen higher DMI rates on some agent-assisted enrollments and wants insurers to investigate agents with disproportionately high rates.

CMS recommends that insurers, beginning November 1, 2026:

• Review enrollment records for warning signs, generally every month
• Review agents with patterns that suggest noncompliance, including high open-DMI rates
• Act within about one month against noncompliant agents, which may include suspending commissions or ending appointments
• Report suspected unauthorized enrollments to CMS

CMS also requires verifiable Social Security numbers or immigration document numbers for all non-newborn applicants on agent-assisted applications, according to its anti-fraud fact sheet.

What CMS Proposed for 2028

The proposed Exchange Pre-Eligibility Verification rule would put the Working Families Tax Cuts law (P.L. 119-21) into effect for 2028 coverage:

• Consumers seeking tax credits or cost-sharing reductions would need household income and family size, citizenship or eligible immigration status, other coverage and residence verified before subsidies begin.
• No subsidies would be paid while certain inconsistencies are pending, though consumers could still enroll without them.
• Returning enrollees would be automatically re-enrolled with financial help only if they return each year to confirm eligibility and have it re-verified. Otherwise, they would be re-enrolled without subsidies.
• A new pre-Open Enrollment verification window would open August 1 each year, starting August 1, 2027 for 2028 coverage.
• Comments are open for 30 days after publication.

The Bigger 2027 Picture

Clients will also see higher costs. The 2027 maximum out-of-pocket limit rises to $12,000 for self-only coverage and $24,000 for families, about 13.2% higher than 2026, according to CMS. KFF Health News reported a median proposed premium increase of about 15%. Carrier participation is shifting too: as of October 7, KFF counted 11 carriers exiting the Marketplaces in some or all states and six entering new states. New agents without a 2026 Exchange agreement remain under CMS’s registration moratorium until February 1, 2027, as covered in our CMS broker moratorium and 760,000 cancellations article. Our ACA Marketplace OEP 2027 guide has the full season plan.

Your Pre-OEP Checklist

1. Confirm your own access. Complete re-identity proofing through Login.gov or ID.me and finish plan year 2027 Marketplace registration and training.
2. Learn your EDE platform’s authorization flow and run a test before November 1.
3. Sort your book by risk level: new applicants, net premiums of $30 or less, clients new to you and clients who moved.
4. ID-proof high-risk clients early. CMS says agents may be able to ID-proof consumers before Open Enrollment once their platform’s tools are live.
5. Confirm client phone numbers and email addresses, since the passcode goes to the consumer.
6. Schedule appointments, don’t cold-call. Book times when clients can respond to a code within 15 minutes.
7. Turn on call recording with a clear consent disclosure, and store recordings securely.
8. Collect complete data: SSNs or document numbers for every non-newborn applicant and realistic income estimates.
9. Watch DMIs weekly and help clients upload documents quickly.
10. Follow state outreach rules. Open Enrollment opens on a Sunday, and some states, including Pennsylvania, restrict sales calls and texts on Sundays.

How Affordable Care Agents Supports ACA Brokers

Affordable Care Agents is a national FMO, IMO and insurance brokerage. If you are new to the model, here is what an FMO does for brokers. Our brokers get:

• Carrier contracting across ACA Marketplace, ancillary, Medicare and life lines
• Compliance education on consumer authorization, consent documentation, call recording and data-matching issues
• Back-office and enrollment support during Open Enrollment
• Training on efficient, compliant appointment workflows that protect your commissions
• For agents who also serve Medicare clients, AHIP 2027 discount certification through our OIM partnership. See our AHIP 2027 certification guide

Frequently Asked Questions