ACA Marketplace Changes: What Agents Need to Know for 2027 and 2028

Over the past several months, we have received a lot of questions regarding new ACA consent, identity verification, and documentation requirements. Much of the information circulating combines multiple CMS rules with different implementation timelines, which has led to confusion across the agent community.

This summary clarifies what is required, when it takes effect, and how agents should prepare.

The good news is that most agents do not need to fundamentally change their enrollment process today. However, important changes are coming, and preparation should begin now.

The Most Important Thing to Understand

There are two separate sets of changes:

• Changes affecting the 2027 plan year (beginning with Open Enrollment in late 2026)
• Changes affecting the 2028 plan year (beginning with Open Enrollment in late 2027)

Many agents are hearing about 2028 requirements and mistakenly believe they must implement them for 2027 enrollments. They do not. Understanding this distinction is critical to avoiding unnecessary workflow changes or compliance risk.

What Changes for the 2027 Plan Year?

CMS is continuing to strengthen Marketplace program integrity and eligibility verification requirements to reduce improper enrollments and subsidy errors.

Agents Should Expect:

• More eligibility verifications
• Increased income verification when reported income appears inconsistent
• Continued scrutiny of Special Enrollment Period (SEP) eligibility
• Increased oversight of agent and broker activity
• Additional efforts to prevent unauthorized enrollments and subsidy abuse

Consumers may be required to provide documentation supporting:

• Loss of coverage
• Moves
• Marriage
• Birth or adoption
• Income estimates
• Other SEP qualifying events

These requirements are tied to eligibility verification and are typically handled through Marketplace processes.

What This Means for Agents Today

Agents should expect more applications to be flagged for verification and should proactively:

• Set expectations with consumers that documentation may be required after submission
• Avoid submitting SEP enrollments without clearly validating the qualifying event
• Ensure all application information is accurate and consistent with available data
• Document conversations where eligibility or income estimates are discussed

Failure to properly document eligibility or submit accurate information may result in policy corrections, subsidy adjustments, or commission chargebacks. CMS enforcement activity is expected to increase alongside these changes, particularly related to unauthorized enrollments and unsupported eligibility submissions.

Is There a New Government ID Requirement for Every Applicant?

No. At this time, CMS has not finalized a rule requiring every Marketplace applicant to upload a government-issued ID as part of every enrollment.

However, identity verification processes continue to evolve. Some applicants may be required to complete additional identity proofing or provide documentation if verification cannot be completed electronically. Agents should be prepared for more frequent verification requests but should not assume identification is required for every applicant.

What Changes for the 2028 Plan Year?

The most significant workflow changes are expected for the 2028 plan year. CMS has finalized a requirement that agents, brokers, and web-brokers use a standardized HHS Consumer Consent Form and Eligibility Application Review Form beginning with January 1, 2028 enrollments.

This represents a shift from agent-attested enrollments to consumer-acknowledged enrollments.

What Will Be Required

Before submitting an application, agents will need documented evidence that:

• The consumer reviewed their application information
• The consumer confirmed the information is accurate
• The consumer provided consent for enrollment assistance

Consumers will need to take a clear, documented action demonstrating consent. Examples include:

• Electronic signature
• Handwritten signature
• Email confirmation
• Recorded verbal consent
• Other verifiable documentation

What Should Agents Do Right Now?

1. Continue Following Existing Consent Procedures. Maintain all current consent and carrier-specific documentation requirements.

2. Strengthen Documentation Immediately. Agents should consistently document:

• • Date and time of consumer authorization
  • Method of authorization (call, email, e-signature, etc.)
  • Consumer contact information
  • Summary of enrollment discussions
  • SEP eligibility details and supporting rationale

Increased Marketplace scrutiny makes complete documentation essential.

3. Validate Before You Submit. Do not rely on post-submission corrections. Confirm:

• • Income is reasonable and supportable
  • SEP eligibility is clearly established
  • Consumer information has been reviewed with the applicant

4. Begin Incorporating Consumer Acknowledgment. Where possible, begin incorporating:

• • Email confirmations
  • Recorded calls
  • Electronic acknowledgments

This will help align your process with upcoming 2028 requirements.

5. Monitor CMS Guidance Closely. Additional operational guidance and standardized forms are expected. Agents should be prepared to adjust workflows as details are released.

Key Takeaways

2027 Plan Year

• No universal ID requirement for all applicants
• Increased eligibility and income verification
• Greater scrutiny of SEP enrollments
• Strong documentation is essential

2028 Plan Year

• Standardized HHS Consent and Application Review Forms required
• Consumers must actively confirm enrollment information
• Documented consumer action will be mandatory

Agents should begin preparing now, but these requirements do not apply to 2027 enrollments.

As additional CMS guidance becomes available, we will continue to provide updates and practical recommendations.