GAO: Federal ACA Marketplace Still Leaves Consumers Vulnerable to Unauthorized Enrollments

Federal watchdogs said Monday that safeguards in the Affordable Care Act’s federally run health insurance marketplace still leave consumers vulnerable to unauthorized enrollments and plan switches by agents and brokers, even after the government tightened some procedures last year.

In a report published July 13, the Government Accountability Office said complaints tied to confirmed unauthorized enrollments or unauthorized plan switches rose to 299,604 in 2025 from 258,424 in 2024 and 66,548 in 2023 — “more than fourfold” growth over that period. GAO noted those are calendar-year complaint counts based on Centers for Medicare & Medicaid Services data, and CMS told investigators some complaints received in a given year may relate to prior plan years. The report also pointed to GAO’s earlier preliminary investigative findings, released Dec. 3, 2025, that at least 160,000 federal marketplace applications in plan year 2024 had likely unauthorized changes.

The report, titled “Health Insurance Marketplaces: CMS Needs Stronger Controls to Prevent Unauthorized Actions by Agents and Brokers,” said CMS’s existing oversight does not adequately protect consumers. While the agency routinely checks whether federal marketplace agents and brokers are licensed and registered, GAO said “processes to ensure consumer consent for agent or broker actions are weak.” It identified three main gaps: weak consent procedures, failure to limit access to consumer marketplace records to the agent or broker already associated with that person’s enrollment, and failure to notify consumers about all agent or broker actions.

CMS had already adopted additional procedures in 2024 to better ensure consent, but GAO said those measures still do not stop all unauthorized activity. The watchdog found the procedures are not always used, and CMS takes only limited steps to verify a consumer’s identity before an agent or broker acts on the person’s account.

GAO compared the federal marketplace with three state-based exchanges — California, Georgia and New Mexico — and found those states use stronger controls, including one-time passcodes to verify a consumer’s consent. GAO said such tools can better ensure that an agent or broker is acting with the enrollee’s knowledge.

The watchdog made two recommendations to the Department of Health and Human Services, which oversees CMS. First, it said CMS should design and implement stronger controls to verify consumer consent, restrict access to consumer information to the agent of record, and notify consumers of agent or broker activity. Second, it said CMS should periodically review whether those controls remain relevant and effective and update them as needed.

HHS concurred with both recommendations. According to GAO, the department said CMS is considering steps including requiring one-time confirmations or passcodes for Enhanced Direct Enrollment entities — private companies approved to enroll people in marketplace coverage — and restricting access to a consumer’s full application to the agent or broker of record. GAO said CMS had not finalized all changes at the time of the report and was exploring options for possible implementation by the open enrollment period for plan year 2027.

The findings land amid broader concerns about improper enrollments in ACA coverage. Recent Justice Department fraud cases involving brokers and marketing firms have heightened scrutiny of whether some unauthorized sign-ups or plan switches were used to generate commissions and improper federal subsidies.

The stakes are high because millions of people rely on the marketplaces for coverage. GAO said that as of February 2026, more than 19 million consumers were enrolled through federal and state marketplaces. As of January 2026, about 96,000 agents and brokers were registered with the federal marketplace.

For consumers, unauthorized changes can have immediate consequences. GAO said people may lose access to preferred doctors or medications, face higher premiums or out-of-pocket costs, or end up having to repay premium tax credits if income or other eligibility information was misrepresented on their applications.