Insurance Marketing Coalition Responds to DOJ Allegations: A Call for Perspective, Clarity, and Consumer-Centered Reform

May 15, 2025 – Winter Garden, FL

The Insurance Marketing Coalition (IMC), representing ethical marketing leaders in the Health and Medicare insurance ecosystem, acknowledges the seriousness of the recent allegations raised by the Department of Justice regarding practices among certain carriers and digital marketing intermediaries. This moment demands more than reflection. It calls for education, clarity, and a fair understanding of how this market operates.

Most brokers and agents operate within a fragmented and highly restricted landscape. This is not a marketplace with open access or equal footing. The current regulatory framework allows carriers to select which brokers and agents can represent their products. At the same time, brokers must invest heavily in onboarding, compliance, and operational resources to represent even a single carrier. The result is a system where no participant enjoys a level playing field. The DOJ’s complaint assumes financial arrangements distort competition, but it overlooks the deeper constraints that are already built into the structure of this industry.

Second, the complaint seems to confuse the act of marketing with unethical behavior. We reject that assumption. Yes, brokers and agencies advertise. That is not improper. In a privatized system with overlapping coverage options and varying plan types, marketing plays a critical role in consumer awareness. Millions of Americans have gained knowledge of supplemental benefits because they saw an ad, spoke with a licensed agent, and received guidance tailored to their situation.

The reality is far more nuanced than the headlines suggest.

• Benefit Awareness: Widespread outreach has helped more than half of eligible beneficiaries enroll in Medicare Advantage plans. These plans often offer benefits such as dental, vision, and hearing that traditional Medicare does not include.

• Product Choice: While no broker can represent every plan, they are required to disclose what they do and do not offer. Many go beyond what’s required by helping consumers understand the range of options available in their area.

• Human Support: Licensed agents and brokers speak with thousands of Americans each day. Many of those conversations do not result in a sale. Still, agents complete needs assessments, explain drug coverage, and help consumers understand provider networks and budget requirements. Unlike government-run call centers, our members offer real-time, personalized guidance without long waits or rushed answers.

During the most recent Annual Enrollment Period, this commitment became even more important. Several carriers made the decision to exit entire plan regions for 2025. In many cases, consumers were reassigned to different plans or left without coverage entirely. While official notices were sent, they were often overlooked. Brokers and agencies stepped in to help. Through advertising, outbound calls, and educational campaigns, they helped consumers understand what was changing and what actions they could take.

Yes, bad actors exist in every industry. Health insurance is no exception. The DOJ has identified examples that deserve scrutiny, but these examples are not the norm. To suggest that all brokers, agencies, and marketing organizations operate with disregard for ethics is inaccurate and unfair.

IMC continues to advocate for reforms that protect consumers, support independent brokers, and improve transparency. We encourage legislators and regulators to meet with us and learn how this market functions in practice. We believe that better understanding will lead to better policy.

Accountability is important. So is accuracy. And so is preserving the access, guidance, and service that millions of seniors depend on each year.

About IMC

The Insurance Marketing Coalition (IMC) is a non-partisan, non-profit organization dedicated to promoting ethical marketing practices in the Health and Medicare insurance industry. We represent a diverse community of agencies, brokers, and marketing organizations committed to consumer empowerment, informed choice, and transparent coverage support.

Rachel Honoway

Vice President, Insurance Marketing Coalition 

press@imcorg.com 

www.imcorg.com

Understanding the CMS’ 2025 Marketplace Integrity and Affordability Proposed Rule: What Consumers, Brokers, and Marketers Should Expect

by Farzin Espahani, GM Health & Medicare, Quinstreet, and Board Member, IMC

The Centers for Medicare & Medicaid Services (CMS) recently released a proposed rule aimed at addressing improper enrollments in the Affordable Care Act (ACA) Health Insurance Marketplaces. This rule introduces several key changes designed to enhance the integrity of the marketplaces, stabilize the risk pool, and improve health care affordability and access. In this summary, we will explore the major provisions of the proposed rule and their impact on consumers, brokers, and marketers.

Key Provisions and Their Impact

1. Ending Monthly SEP for Low-Income Individuals:

   • Consumers: Individuals with household incomes below 150% of the FPL will no longer have a monthly SEP, which means they need to enroll during the annual Open Enrollment Period or qualify for other SEPs.

   • Brokers: This change will require brokers to emphasize the importance of enrolling during the Open Enrollment Period to avoid gaps in coverage.

   • Marketers: Marketers should develop campaigns that highlight the importance of enrolling during the Open Enrollment Period and the consequences of missing this window.

2. Strengthening Pre-Enrollment Verification:

   • Consumers: More rigorous verification processes for SEPs and additional income verification when tax data is unavailable will be implemented. This aims to reduce improper enrollments and ensure eligibility accuracy.

   • Brokers: Brokers will need to assist clients in navigating these verification processes and ensure all necessary documentation is provided.

   • Marketers: Marketers should create educational content that explains the new verification requirements and the importance of providing accurate information.

3. New Enrollment Verification Measures:

   • Consumers: A small $5 monthly premium will be required until enrollees confirm or update their eligibility for full subsidies. This measure is intended to encourage timely verification and reduce fraudulent enrollments.

   • Brokers: Brokers should inform clients about this new requirement and help them complete the verification process promptly to avoid unnecessary costs.

   • Marketers: Marketers should communicate the new premium requirement clearly and emphasize the need for timely verification to avoid additional costs.

4. Adjusting the ACA Open Enrollment Period:

   • Consumers: The Open Enrollment Period deadline will be moved to December 15, ensuring coverage selections are finalized before the new year. This change aims to prevent potential gaps in coverage.

   • Brokers: Brokers will need to adjust their timelines and outreach strategies to ensure clients are aware of the new deadline and enroll on time.

   • Marketers: Marketers should launch targeted campaigns to inform consumers about the new deadline and the importance of enrolling before December 15.

Overall Impact

The proposed rule is designed to stabilize the risk pool, lower premiums, and reduce improper enrollments, ultimately improving health care affordability and access while maintaining fiscal responsibility. For brokers, this means greater emphasis on educating clients about the importance of timely enrollment and verification processes. For consumers, it highlights the need for proactive engagement with the enrollment process to ensure continuous and accurate coverage. For marketers, it underscores the importance of clear communication and targeted campaigns to ensure consumers and brokers are well-informed about the new rules and deadlines.

Insurance Journal: Insurance Group Touts Major Victory Over FCC Rule That Would Have Limited Robocalls

A federal appeals court and the Federal Communications Commission, in one of its first actions under the new presidential administration, have handed down major decisions that many in the insurance industry may see as a double-edged sword.

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