CMS Encourages Marketplace Carriers to Increase Agent Oversight & Implement Call Recording

On October 19, the Centers for Medicare & Medicaid Services (CMS) released new guidance encouraging marketplace insurers to take a more active role in overseeing agents.

Although this guidance is directed toward carriers in the Under-65 market, these updates will affect agents for the 2027 Open Enrollment Period (OEP).

CMS has positioned these changes as recommended best practices rather than mandatory. However, carriers may begin to relay to agents that these are compliance requirements, creating new expectations for agents selling Affordable Care Act (ACA) plans this year.

Watch this video from Integrity for the highlights:

Here’s what CMS is recommending for marketplace insurers, why it impacts agents, and what you should do to be prepared for the OEP.

What Is CMS Recommending ACA Health Insurers Monitor?

To address ongoing concerns of unauthorized broker activity in the marketplace, CMS is encouraging ACA carriers to strengthen their oversight of appointed agents via:

• Monthly monitoring of agent enrollment activity
• Reviewing open data matching issues (DMIs)
• Tracking agent investigations and consumer complaints
• Taking prompt action when potential noncompliance is identified
• Monitoring for unauthorized enrollments or plan changes
• Implementing a phased approach to recording marketplace sales and enrollment calls

CMS recommends that carriers encourage agents to be proactive about these changes before they become official requirements.

Is Call Recording Required for ACA Agents?

In the Medicare Advantage and Part D industry, call recording has proven to be a successful practice according to CMS. Within their recently released ACA best practices for carrier oversight, CMS recommends marketplace insurers direct their appointed agents to record calls with consumers starting this Open Enrollment Period (OEP).

As a best practice, they encourage the recording of enrollment, marketing, and calls that may result in enrollment. Call recording can be an excellent strategy for agents to create documentation of proper enrollment and authorization.

Be aware that as carriers reinforce these suggestions, you could be on the receiving end of increased scrutiny surrounding activity, documentation practices, and consumer interactions.

What Could Increased ACA Oversight Look Like?

If carriers adopt CMS’ recommendations, you may experience:

More Enrollment Monitoring

ACA carriers could crack down and heavily review applications, enrollment volumes, and consumer complaints.

Faster Compliance Interventions

Insurers may quickly investigate potential unauthorized enrollments, application discrepancies, and other compliance concerns.

Additional Documentation Requirements

You may be asked to maintain complete records of consumer interactions and enrollment conversations.

Expanded Use of Call Recording

Carriers could encourage or require agents to use call recording software and programs, such as IntegrityCONNECT, to record enrollment-related calls and maintain those records for compliance purposes.

How to Prepare Now

Even though the guidance is not currently a federal mandate for agents, taking proactive steps now could help prevent future compliance headaches.

We suggest you:

• Review your current enrollment and documentation processes
• Respond promptly to carrier inquiries and compliance requests
• Maintain detailed records of consumer conversations and enrollment decisions
• Stay informed about carrier-specific appointment requirements
• Evaluate technology solutions that support both enrollment and call recording

By taking steps to get ahead of possible coming requirements, you’ll be prepared if these become compliance standards!

What This Means for the 2027 Open Enrollment Period and Beyond

Many industry observers view this guidance as part of an ongoing shift toward greater marketplace oversight and accountability.

Although these are not federal requirements now, the industry has seen previous best practices evolve into more formal compliance expectations over time.

You should view this guidance as an early signal of where regulations may be headed rather than simply a short-term carrier suggestion.

Remaining informed, maintaining strong documentation practices, and leveraging compliant enrollment technology will be increasingly important as the marketplace continues to evolve.

With Ritter, you have access to ACA carrier contracts, enrollment tools, and a dedicated Under-65 Sales team ready to help you navigate industry changes with confidence. Start recording client calls with confidence in IntegrityCONNECT and manage your business and documentation in one place!