New Ambetter Health Agent of Record (AOR) Rule
Beginning with Jan. 1, 2025 effective date policies, Ambetter Health will discontinue our current Agent of Record (AOR) lock-in rule and rely solely on the Center for Medicare & Medicaid Services (CMS) AOR process for plan year 2025 and beyond.
The current AOR lock-in rule will continue to apply to plan year 2024 policies.
Per CMS Press Release, July 19, 2024:
“Starting on July 19, 2024, CMS will block an agent or broker from making changes to a consumer’s FFM enrollment unless the agent is already associated with the consumer’s enrollment. Today’s new steps build on CMS’ previous work to protect consumers on the FFM by suspending and terminating agents and brokers who perform unauthorized Marketplace activity.
An agent or broker who is not already associated with a consumer’s enrollment must now take additional steps to update a consumer’s Marketplace enrollment, even with their consent. Unassociated or “new” agents and brokers will be required to conduct a three-way call with the consumer and the Marketplace Call Center or to direct the consumer to submit the change themselves through HealthCare.gov or via an approved Classic Direct Enrollment or Enhanced Direct Enrollment partner website with a consumer pathway.”
CMS Statement on System Changes to Stop Unauthorized Agent and Broker Marketplace Activity | CMS
The Centers for Medicare & Medicaid Services (CMS) is committed to protecting consumers from bad actors and ensuring the program integrity of the Federally-facilitated Marketplace (FFM). That’s why CMS is taking additional action to address increases in unauthorized changes in consumers’ enrollments by agents and brokers. Starting on July 19, 2024, CMS will block an agent or broker from making changes to a consumer’s FFM enrollment unless the agent is already associated with the consumer’s enrollment.
