Individual health insurance markets strengthened by policy reforms

By: David Merritt, Blue Cross Blue Shield Association Senior Vice President of External Affairs

Everyone deserves high-quality, affordable health care coverage, and the individual marketplaces provide a vital source for millions of Americans, with over 24 million consumers enrolling for 2025.

We know these marketplaces need to work for both the enrollees who depend on them and the hardworking taxpayers who pay for them. That’s why the Blue Cross Blue Shield Association (BCBSA) welcomes recent changes that will stop unscrupulous agents, brokers and marketers from taking advantage of patients and defrauding the federal government.

Those changes include:

In 2024, the Centers for Medicare and Medicaid Services (CMS) strengthened their oversight of agents and brokers.

• New account safeguards block agents and brokers from making unauthorized changes to enrollees’ coverage. We are also seeing an increased effort to investigate suspicious agent and broker activity, including Healthcare.gov Direct Enrollment suspensions when warranted.

Last month, CMS released a proposed rule to further strengthen the integrity of the marketplaces. The proposed changes reflect steps BCBSA has long advocated for—enhanced income verification, special enrollment period (SEP) eligibility and assessment of other enrollment factors.

• End the monthly SEP, which allows people to wait until they are sick or injured to purchase coverage on the marketplaces. Even with this change, families can still access coverage in times of need, such as job loss, the death of a spouse or aging out of a parent’s plan. Limiting SEPs to true life changes would help prevent behavior that, if left unchecked, could raise premiums by 3-4 percent.
• Strengthening the verification process for people who use the SEP. If you lose coverage for a qualifying life event like job loss, you should be able to access the marketplaces. But we need a robust verification process to ensure no one is gaming the system. Limiting access to those who are eligible keeps premiums affordable. To reduce the burden on everyone, federal and state governments should invest both in technology that automates eligibility verification as well as live enrollment assistance for consumers who need it.

These eligibility and oversight improvements proposed by CMS, along with the actions taken by the previous administration, ensure that the program is both effective and accountable.

We’re encouraged to see the marketplaces actively becoming a more resilient and consumer-focused system. Congress should extend vital premium assistance and avoid higher costs for the millions of Americans relying on the Individual marketplaces to access affordable coverage at the end of the year.