Unauthorized Marketplace Health Plan Enrollment for Medicaid Members

The Centers for Medicare and Medicaid Services (CMS) and Department of Health and Human Services (HHS) issued a warning regarding unauthorized Federally-Facilitated Marketplace (FFM) agent and broker fraud in the Health Insurance Marketplace.

Contact Marketplace Call Center: 1.800.318.2596 (TTY: 1.855.889.4325).

This can happen to anyone and involves enrollment in a Marketplace insurance plan without their knowledge. It is happening across the nation to consumers who have other health insurance coverage such as an employer-sponsored plan, Marketplace coverage, and Medicaid. Unauthorized enrollment for Medicaid members in a Marketplace health insurance plan can cause confusion, issues in accessing care, delays in receiving medical services, and unnecessary costs to members.

One key consideration is that Medicaid will become the secondary payor. Additionally, the member will not be eligible for Marketplace savings (i.e., subsidies) to help make a Marketplace plan more affordable. For these reasons, HHS encourages Marketplace members to end Marketplace coverage if they qualify for Medicaid. See if you qualify for AHCCCS by visiting: https://www.azahcccs.gov/Members/GetCovered/

Suspect Fraud? Contact the Marketplace Call Center: 1.800.318.2596 (TTY: 1.855.889.4325).

Warning Signs of Marketplace Fraud

  • Offering cash, gifts, or other perks, to enroll you in Marketplace or "Obamacare" insurance. Federal authorities advise that you should never share your information with anyone offering cash, gifts, or other perks. The information you share could be used without your consent.
  • Requesting personal information when you did not contact them to try to steal your identity. No one from the government will call or email you to sell an insurance plan or ask for personal identifying information. Be careful when giving out personal information (credit card, banking, or Social Security numbers).
  • Threatening legal action if you do not sign up for a plan. High-pressure visits, mail solicitations, emails, and phone calls from people pretending to work for the government. Always ask for identification if someone comes to your door.
  • Sham websites. Always look for official government seals, logos, or website addresses that end in “.gov.”
  1. How is unauthorized enrollment in the ACA Marketplace occurring?

    Unauthorized enrollments typically occur through brokers and agents using deceptive or coercive marketing practices or unauthorized use of personal data to enroll people without their consent.

  2. What happens to my AHCCCS plan if I have been enrolled in an ACA Marketplace plan without my consent?

    No changes will be made to your current AHCCCS coverage; however, AHCCCS will become the secondary payor. This means the Marketplace plan becomes the primary payor for claims rather than Medicaid. Additionally, the member will not be eligible for Marketplace savings (i.e., subsidies) to help make a Marketplace plan more affordable. It can cause confusion, issues in accessing care, and unnecessary costs to members (e.g., premiums, cost-shares, etc.).

  3. Who should I contact if I know or suspect that I have been enrolled in an ACA Marketplace plan without my consent?

    The US Department of Health and Human Services recommends contacting the ACA Marketplace Call Center directly at 1.800.318.2596 (TTY: 1.855.889.4325) to end the ACA Marketplace plan or to verify that you have not been enrolled in a Marketplace plan. Any AHCCCS members who have experienced a barrier to health care services due to being enrolled in a Marketplace plan without their consent can contact the AHCCCS Clinical Resolutions Unit (CRU) to help find a resolution at 602.364.4558 or 1.800.867.5808.

  4. What can I do to protect against unauthorized enrollment?

    CMS has provided multiple resources to help consumers stay vigilant and protect against unauthorized enrollment.

Other Helpful Resources/Websites