Florida resident Keith Jones says his Affordable Care Act insurance plan was changed multiple times this year without his permission. Now the 52-year-old is struggling with his health problems while facing large premium bills he says he shouldn’t owe.
The third time, he sought help from an insurance agent, who got Jones on the phone with the federal healthcare.gov call center to sort things out. During that call, “literally, there was someone opening a new policy without my consent,” Jones said.
Despite new rules that went into effect in mid-2024 aimed at thwarting such unauthorized ACA changes, it’s still happening, said Florida-based agent Jason Fine, who is trying to help Jones and dozens of other clients unravel such switches.
The Government Accountability Office, an independent government watchdog, on Dec. 3 issued a sharply critical, though preliminary, report saying that years of similar GAO warnings to federal officials have not produced results needed to better protect against ACA enrollment fraud. Alarms were raised during the Obama and Biden administrations, as well as the first Trump administration.
There were more than 275,000 complaints to the Centers for Medicare & Medicaid Services about unauthorized ACA enrollments and plan-switching in 2024, according to the agency, which also administers Obamacare coverage.
“The absolute bottom line is nothing has changed in terms of risk,” Seto J. Bagdoyan, a co-author of the GAO report, said in an interview with KFF Health News. Bagdoyan is the director of audit services for the agency’s Forensic Audits and Investigative Service team.
The report landed as Congress continues to be embroiled in the issue of whether to extend the more generous tax subsidies that have given consumers extra help paying their Obamacare premiums in recent years. Some ACA critics have said the subsidies fuel enrollment fraud.
Citing fraud concerns, GOP la …