ACA shoppers face new ID checks and premium hikes

Open enrollment for Affordable Care Act health coverage began on Nov. 1 for most states, introducing a series of administrative hurdles and cost changes for 2027. These shifts include new identity verification steps for many applicants and continued premium increases following the expiration of enhanced subsidies.

The Centers for Medicare & Medicaid Services has implemented stricter rules to combat fraud in the federal marketplace, which serves 29 states. Consumers using brokers or agents will receive a one-time confirmation code via text, email, or automated phone call to authorize the agent. This step is required to verify that the consumer consented to the enrollment or change.

Applicants designated as high-risk face additional scrutiny. CMS defines this group to include first-time applicants, those changing states, individuals switching agents, and those paying monthly premiums of $30 or less. These consumers must verify their identity through third-party services such as Experian before an agent can act on their behalf. If verification fails, applicants may need to create a healthcare.gov account and upload identification documents like driver's licenses or passports.

Joshua Brooker, an insurance agency owner in Pennsylvania, noted that the rules target potential impersonation by brokers. He expressed concern that up to one in five consumers may face extra identity proofing, potentially discouraging them from enrolling. Stacey Pogue, a senior research fellow at Georgetown University, observed that while the measures target fraud, they may create unnecessary hurdles for people with limited credit histories or recent name changes.

A separate CMS rule issued in September pauses the registration of new brokers for the 2027 open enrollment period. Agents not registered with the federal marketplace in 2026 cannot assist with enrollments until at least February. This delay extends beyond the end of the enrollment season. CMS stated that a disproportionate number of compliance issues in 2026 involved newly registered agents.

Jason Fine, a Florida brokerage owner, agreed with the fraud prevention goals but warned of short-term chaos. His agency, with a core staff of five, planned to hire up to 10 additional agents but faces difficulties finding staff registered in 2026. He suggested the moratorium benefits larger call centers that can maintain year-round staffing levels of 25 to 40 people. The National Association of Benefits and Insurance Professionals filed a lawsuit on Oct. 15 against the administration, arguing the rule unfairly impacts 19,000 new agents.

Premiums for 2027 coverage are expected to rise by 15%, a lower increase than the 26% average seen last year. Most shoppers will still receive subsidies, though these are less generous than the enhanced rates that expired at the end of 2025. Subsidy eligibility cuts off for households earning more than four times the federal poverty rate, which is $63,840 for a single person and $109,280 for a family of three during this enrollment period.

Louise Norris, a health policy analyst, stated that overall affordability for most people will remain similar to current levels. However, the out-of-pocket maximum, which is the most a consumer pays before the insurer covers costs, will increase by 13%. For 2027, this cap rises to $12,000 for individual plans and $24,000 for family plans. Experts advise shoppers to compare plans rather than allowing automatic renewals, as deductibles and coverage details can change annually.

The One Big Beautiful Bill Act also alters subsidy eligibility for certain immigrants. The law removes subsidy access for many lawfully present residents, including those with H-1B visas, temporary protected status, or pending green-card applications. Subsidies remain available for green-card holders, specific Cuban and Haitian immigrants, and citizens of Micronesia, the Marshall Islands, and Palau.