The Affordable Care Act - Everything You Need to Know
Since its inception in 2010, the Affordable Care Act has seen a steady rise in membership growth. Offering under-65 products is an excellent strategy to expand your business and bolster your pipeline for Medicare sales.
What are the qualification requirements for ACA?
Affordable Care Act products are incredibly easy to sell, with just three eligibility requirements.
US Citizen or Lawfully Present
Does Not Have Medicare
Not Incarcerated
What makes integrating the Affordable Care Act into your portfolio a smart move for agents?
- Over 70% of applicants qualify for subsidies, which contribute towards premium costs, ensuring affordability for enrollees.
- The trend of people transitioning away from traditional 9-5 employment and employer health plans is on the rise.
- Enjoy monthly commissions based on the number of members you enroll.
- Certification typically involves just one FREE test for federal exchange-based states, while state-based exchanges often offer testing at no charge as well.
- Affordable Care Act Plans offer comparatively lighter regulation than other insurance types.
- Allow us to educate you on the products that can enhance your client accounts. Statistics show a 60%-70% likelihood of selling an additional product to existing clients, compared to only 5%-20% for new clients. Maximize your business potential by expanding your offerings.
Do commissions pay for SEP enrollments?
Yes. Carriers do not pay until they receive member premium and subsidy. On average 2-3 months after the effective date.
When can I enroll in ACA?
You can enroll during Open Enrollment from November 1 – January 15 or during the year if you have a Special Election Period/Qualifying Life Event.
How is ACA effective date determined?
During OEP, submissions between 11/1 -12/15 are effective 1/1 and apps submitted by 1/15 are effective for 2/1. If using an SEP, normally the first of month after submission of an application.
What happens if I need help with Broker Service Access?
Each carrier has a Broker Service team for issues with policy issuance, changes, etc.
What enrollment platform do you use?
HealthSherpa is the platform we provide but we do not require you to use it.
Do I need the full marketplace certification each year?
No. If you certify in continuous years, you only do the refresher certification after the first year.
What is a Qualifying Life Event?
There are 4 Types of Qualifying Events for ACA
Loss of Health Coverage
- Losing existing health plan
- Losing eligibility for Medicaid or Chip
- Turning 26 and losing coverage on your parents’ plan
Changes in Household
- Getting married/divorced
- Having or adopting a child
- Death in the family
Changes in Residence
- Moving to a new zip code or county
- Student moving to or from the place they attend school
- Seasonal worker moving to or from the place they live and work
- Moving to or from a shelter or transitional housing
Other Events
- Changes in income that affect the coverage you qualify for
- Gaining membership into a federally recognized tribe/Alaskan Native
- Becoming a US Citizen
- Leaving incarceration (jail or prison)
- Americorps members starting or ending service
What happens if I have trouble with HealthSherpa?
Reach out to Danielle Byers or use the HealthSherpa help feature.
How are subsidies calculated?
Subsidies are calculated by the zip code, household size and household income
What info do I need to run a quote?
Zip code, date of birth for all members needing coverage, tobacco usage, household size, household income (estimated amount for the current year they will be insured.
What is the difference between the Federal Exchange and State Based Exchanges?
The difference is in who makes the decisions and runs the exchange. 19 States elected to run their own state based exchanges. These require separate certifications.
Are dental & vision available?
Yes. D/V are included for children automatically up to age 19. Adults can choose to buy a dental/vision plan separately either on the exchange or straight from a carrier.
What is an ICHRA?
Individual Coverage Health Reimbursement Arrangement. A new type of arrangement where employers of any size can reimburse employees a set amount for the employee to use to purchase health insurance from the Marketplace on their own.
What is a QSEHRA?
Qualified Small Employer Health Reimbursement Arrangement. Similar to the ICHRA arrangement but specific to Qualified Small Employers who do not offer group coverage to their employees.
Do commissions pay for SEP enrollments?
Yes. Carriers do not pay until they receive member premium and subsidy. On average 2-3 months after the effective date.
When can I enroll in ACA?
You can enroll during Open Enrollment from November 1 – January 15 or during the year if you have a Special Election Period/Qualifying Life Event.
How is ACA effective date determined?
During OEP, submissions between 11/1 -12/15 are effective 1/1 and apps submitted by 1/15 are effective for 2/1. If using an SEP, normally the first of month after submission of an application.
Do I need the full marketplace certification each year?
No. If you certify in continuous years, you only do the refresher certification after the first year.
What enrollment platform do you use?
HealthSherpa is the platform we provide but we do not require you to use it.
What happens if I need help with Broker Service Access?
Each carrier has a Broker Service team for issues with policy issuance, changes, etc.
What is a Qualifying Life Event?
There are 4 Types of Qualifying Events for ACA
Loss of Health Coverage
- Losing existing health plan
- Losing eligibility for Medicaid or Chip
- Turning 26 and losing coverage on your parents’ plan
Changes in Household
- Getting married/divorced
- Having or adopting a child
- Death in the family
Changes in Residence
- Moving to a new zip code or county
- Student moving to or from the place they attend school
- Seasonal worker moving to or from the place they live and work
- Moving to or from a shelter or transitional housing
Other Events
- Changes in income that affect the coverage you qualify for
- Gaining membership into a federally recognized tribe/Alaskan Native
- Becoming a US Citizen
- Leaving incarceration (jail or prison)
- Americorps members starting or ending service
What happens if I have trouble with HealthSherpa?
Reach out to Danielle Byers or use the HealthSherpa help feature.
How are subsidies calculated?
Subsidies are calculated by the zip code, household size and household income
What info do I need to run a quote?
Zip code, date of birth for all members needing coverage, tobacco usage, household size, household income (estimated amount for the current year they will be insured.
What is the difference between the Federal Exchange and State Based Exchanges?
The difference is in who makes the decisions and runs the exchange. 19 States elected to run their own state based exchanges. These require separate certifications.
Are dental & vision available?
Yes. D/V are included for children automatically up to age 19. Adults can choose to buy a dental/vision plan separately either on the exchange or straight from a carrier.
What is an ICHRA?
Individual Coverage Health Reimbursement Arrangement. A new type of arrangement where employers of any size can reimburse employees a set amount for the employee to use to purchase health insurance from the Marketplace on their own.
What is a QSEHRA?
Qualified Small Employer Health Reimbursement Arrangement. Similar to the ICHRA arrangement but specific to Qualified Small Employers who do not offer group coverage to their employees.
