Title: Health Insurance Marketplace Agents' Scams and the Efforts to Prevent Them Related work: GAO-26-108041 GAO-26-108297, Health Insurance Marketplaces: CMS Needs Stronger Controls to Prevent Unauthorized Actions by Agents and Brokers Description: Consumers can use the help of a broker or agent to help them navigate government-run health insurance marketplaces. Agents can be useful in helping consumers pick the best insurance plan. But recent federal fraud cases have highlighted concerns that some of these agents may not be licensed and could be costing consumers money through unauthorized changes to plans. We learn more about this issue from GAO's John Dicken. Released: July 2026 {MUSIC} [Holly Hobbs:] This is GAO's Watchdog Report, your source for fact-based, nonpartisan news and information from the U.S. Government Accountability Office—I'm Holly Hobbs. This year, more than 19 million people enrolled in health insurance plans offered through federal or state-run marketplaces. While consumers can enroll independently, many seek free assistance from agents or brokers to help them navigate coverage options.Recently, federal fraud cases have highlighted concerns that some of these agents and brokers may not be licensed and could be costing consumers money through unauthorized changes to their plans. We'll learn more about this issue from GAO's John Dicken. John, thanks for joining us. [John Dicken:] Thank you. [Holly Hobbs:] So, John, let's start with why would someone pose as a health insurance broker or agent? What do they have to gain? [John Dicken:] Yeah. Brokers and agents are not paid by the consumers that are buying insurance, but they are getting commissions and other payments from the health plans that are selected. And so often those could be $20 or more dollars per each enrollee per month. And so, over time, there could be significant commissions associated with individuals enrolling in a plan. [Holly Hobbs:] Do we know how often this is happening? [John Dicken:] We saw that there were an increasing number of complaints to CMS. That, by 2025, there were nearly 300,000 complaints to CMS that there had been unauthorized either enrollments or changes in health plans by brokers and agents on behalf of consumers. We also had done our own investigation and found at least 160,000 cases of unauthorized changes by agents and brokers. [Holly Hobbs:] There was a recent case of this, right? What happened? [John Dicken:] Both CMS and the Department of Justice recently came to sentencing a large activity by unauthorized brokers and agents where they had used identities for thousands of individuals, often homeless or low-income individuals, and enrolled them in plans and changed those plans frequently to get those commissions. [Holly Hobbs:] So they're getting this commission off the health insurer. But what's the impact to the consumer? [John Dicken:] For a consumer who is hoping to be enrolled in a plan or believes they were enrolled in a certain plan, they may not know that there's been a change. But yeah, it may affect their taxes when they're submitting their taxes, or when they try to get health benefits and have prescription drug or a physician visit and the health plan coverage is not what they had expected. [Holly Hobbs:] So if I'm enrolling in one of these federal- or state-run health insurance marketplaces, I'm looking for insurance, are there some red flags that I should look out for to know whether the agent that I'm working with, or the broker, is legit? [John Dicken:] Most individuals are working with agents/brokers, most of whom are providing services on behalf of the consumers and getting their consent. But yeah, I think some of the red flags, there have been marketing practices that may offer even payments or indicate that there could be a guarantees of no premium payments for the individual. And so, it's important to verify information that they may be sharing on healthcare.gov that would be publicly available about the health plans. [Holly Hobbs:] Some of these marketplaces are run by the federal government and some are run by the states. Who's responsible for ensuring that the agents or brokers are certified, or whatever they need to be, to be there? [John Dicken:] For the federal government, HHS and the Centers for Medicare, Medicaid Services have primary responsibility for overseeing the marketplaces where individuals are getting health plans. In some cases, states are directly running their own marketplaces, and in all states, states are responsible for licensing agents and brokers. And so, it's a shared responsibility between the federal agencies and state insurance departments. [Holly Hobbs:] So we've seen concerns about this. Has CMS taken action? [John Dicken:] CMS has taken some actions. They have tried to clarify the consent that consumers are providing and how that's documented. They've also, in some cases, required that, if a new agent is involved in making a change, that there might need to be a three-way call where the individual, the consumer themselves, the agent, are both on the phone with the call center representative before that change can be made. [Holly Hobbs:] What about the states? [John Dicken:] We looked at several states that are running their own marketplaces. So, in states like California, New Mexico and Georgia, there's more limited access that agents can have if they're not the primary agent to the information for consumers. And they often will require confirmation, such as a one-time pass code, to ensure that the consumer's aware of changes that the agency and brokers may be making. [Holly Hobbs:] So this is still a concern. Are we recommending that CMS take action? [John Dicken:] We do have recommendations for CMS and are recommending that they take more action to assure that unauthorized changes are not being made. Some of that would require more verification of the individual's consent. It could be a one-time pass code that the individual is sent to assure that they're aware of changes an agent is making, and also to limit the availability of information to agents and brokers only to those agents that are directly involved with a consumer's enrollment as their primary agent or broker. [Holly Hobbs:] Last question. What's the bottom line of this report? [John Dicken:] Yeah, certainly for the Americans that have been enrolled in marketplace plans, most are relying on agents or brokers to help them in making their enrollments and plan decisions. But unfortunately, we've seen thousands of cases where there were fraudulent or unauthorized changes made. And so, we're recommending CMS take further steps to try to prevent those unauthorized changes to ensure that individuals are getting the health plan coverage that they consent to. [Holly Hobbs:] John, thanks for your time. [John Dicken:] Thank you. {Music} [Holly Hobbs:] And thank you for listening to the Watchdog Report. To hear more podcasts, subscribe to us on Apple Podcasts, Spotify or wherever you listen. And make sure to leave a rating and review to let others know about the work we're doing. For more from the congressional watchdog, the U.S. Government Accountability Office, visit us at GAO.gov.