PHOENIX, AZ — - The Centers for Medicare and Medicaid Services (CMS) and US Department of Health and Human Services (HHS) have issued several public notices about unauthorized activity by health insurance agents and brokers. These agents and brokers have been enrolling consumers into Accountable Care Act (ACA) Marketplace health plans without their knowledge or consent. These notices were issued by CMS in April, May, July and October of 2024, highlighting that unauthorized Marketplace enrollment is a nationwide issue that authorities are committed to addressing.
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/
Consumers who believe they may have been the victim of unauthorized agent or broker activity should call the Marketplace Call Center at 1.800.318.2596 (TTY: 1.855.889.4325) to resolve any coverage issues. More information about changing insurance plans from Marketplace to Medicaid can be found on Healthcare.gov. CMS has also created this infographic to provide guidance to consumers.
AHCCCS is proactively reaching out to members to raise awareness of this issue, inform consumers of the warning signs, and to report any unauthorized activity to the Marketplace Call Center. AHCCCS continues to monitor its data for concerning trends and will be releasing more information as it becomes available. 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. Members can speak with a CRU specialist by calling 602.364.4558 or 1.800.867.5808. Visit the AHCCCS webpage for more information Unauthorized Marketplace Health Plan Enrollment for Medicaid Members
Founded in 1982, the Arizona Health Care Cost Containment System (AHCCCS) is Arizona's Medicaid agency that offers health care programs to serve Arizona residents. Built on a system of competition and choice, AHCCCS operates under an integrated managed care model, through a Research and Demonstration 1115 Waiver. Contracted health plans coordinate and pay for physical and behavioral health care services delivered by more than 100,000 health care providers to more than 2 million Arizonans.
