ACA Open Enrollment Opens With Stricter Rules

Open enrollment for Affordable Care Act health insurance begins November 1 in most states. Shoppers face a more complex process this year due to new federal identity verification requirements and a temporary freeze on new brokers. These changes aim to reduce fraud but may slow down the enrollment period for consumers and agents alike.

The federal marketplace serves 29 states. The Centers for Medicare & Medicaid Services issued the new rules to target improper enrollments. Consumers using agents or brokers must now complete additional steps to authorize their representatives. This process did not exist in previous years.

In August, the administration canceled policies for 760,000 enrollees suspected of improper sign-ups. A small number have since regained coverage. The agency cited a disproportionate number of compliance issues from newly registered agents as the reason for the current restrictions.

New rules require consumers to receive a one-time confirmation code via text, email, or phone call. This code authorizes a specific agent to act on their behalf. Consumers designated as high-risk must also verify their identity through a third-party service like Experian. High-risk categories include first-time applicants, those changing states, and those with monthly premiums of $30 or less.

Joshua Brooker, an insurance agency owner in Pennsylvania, noted that the $30 threshold targets plans where policyholders might not notice unauthorized changes. He warned that up to one in five consumers may face extra identity proofing. Stacey Pogue, a research fellow at Georgetown University, said the measures might create hurdles for people without established credit files.

The number of available brokers will also shrink. CMS issued a rule in September that pauses enrollment assistance for agents not registered with the federal marketplace in 2026. These new brokers cannot assist with 2027 enrollments until February. This deadline falls after the end of the standard open enrollment season.

Jason Fine, a Florida brokerage owner, said the moratorium complicates staffing plans for small agencies. He planned to hire up to 10 new agents but expects difficulty finding those registered in 2026. He noted that larger call centers with year-round staffs benefit from the rule. Agent groups have pushed back legally, with two filing lawsuits in October.

Premiums are expected to rise by 15% for 2027. This follows a 26% increase last year. Enhanced subsidies expired at the end of 2025, meaning higher earners lost financial assistance. However, most shoppers will still receive reduced subsidies based on income.

Subsidy eligibility cuts off for households earning more than four times the federal poverty rate. For a single person, that limit is $63,840. For a family of three, it is $109,280. The One Big Beautiful Bill Act also removes subsidy eligibility for many lawfully present immigrants, including H-1B visa holders and refugees.

Out-of-pocket maximums will also increase by 13%. The cap for an individual plan will rise to $12,000, while family plans will reach $24,000. Experts advise consumers to compare plans actively rather than allowing auto-renewal. Premiums and coverage details can change annually, and some insurers like Cigna have exited certain markets.