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Affordable Care Act Carriers

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.

ICHRA - Affordable Care Act

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.

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Aetna

 

Aetna is an American managed health care company that provides traditional and consumer-directed health care insurance and related services, such as medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans, primarily through employer-paid insurance and benefit programs1. Aetna is a proud CVS Health company and shares a common purpose with CVS Health: bringing their heart to every moment of your health. Aetna believes that everyone should have a fair and just opportunity to achieve their best health, which is known as health equity. Aetna is committed to improving the environment, addressing health inequalities, investing in people’s health, acting with integrity and protecting against health care fraud and abuse.

Clover Health Certification Requirements for 2024

  • Details refer to certification for Clover Health. AHIP certification must be completed separately.

Clover Health Certification Links, Guides, Phone Numbers, Emails

Clover Health Certification Requirements for 2024

  • Details refer to certification for Clover Health. AHIP certification must be completed separately.

Clover Health Certification Links, Guides, Phone Numbers, Emails

Medicare Sales Training Guide

This comprehensive 64-page guide covers senior insurance sales from all angles, from licensing to sales.

“Medicare 101” details coverage types, benefits, eligibility requirements & more!

WellCare Producer Certification Requirements for 2024

  • Details refer to certification for WellCare. AHIP certification must be completed separately.
  • Passing score is 85%.
  • 3 attempts.

WellCare Certification Links, Guides, Phone Numbers, Emails

WellCare Producer Certification Requirements for 2024

  • Details refer to certification for WellCare. AHIP certification must be completed separately.
  • Passing score is 85%.
  • 3 attempts.

WellCare Certification Links, Guides, Phone Numbers, Emails

Shared Health of MS Producer Certification Requirements for 2024

  • Details refer to certification for Shared Health of MS. AHIP certification must be completed separately.
  • More information coming soon!

Shared Health of MS Producer Certification Requirements for 2024

  • Details refer to certification for Shared Health of MS. AHIP certification must be completed separately.
  • More information coming soon!

Devoted Health Certification Requirements for 2024

  • Details refer to certification for Devoted Health. AHIP certification must be completed separately.

Devoted Health Certification Links, Guides, Contact Info

Devoted Health Certification Requirements for 2024

  • Details refer to certification for Devoted Health. AHIP certification must be completed separately.

Devoted Health Certification Links, Guides, Contact Info

Humana Producer Certification Requirements for 2024

  • Details refer to certification for Humana. AHIP certification must be completed separately.
  • English Cert/Recert is now open.
  • To access this training you will login at www.Humana.com, then click on the “Get Certified/Recertify” button from the Humana Vantage home page.

  • If you have completed the Humana PY23 Certification and are currently certified to sell Humana Medicare products, the deadline will be 5:00 pm Eastern on Thursday, November 30, 2023, to complete the PY24 Recertification.

  • Spanish Cert/Recert will be launching later in the summer. More information coming soon.

Certification Links, Guides, Phone Numbers, Emails

Humana Producer Certification Requirements for 2024

  • Details refer to certification for Humana. AHIP certification must be completed separately.
  • English Cert/Recert is now open.
  • To access this training you will login at www.Humana.com, then click on the “Get Certified/Recertify” button from the Humana Vantage home page.

  • If you have completed the Humana PY23 Certification and are currently certified to sell Humana Medicare products, the deadline will be 5:00 pm Eastern on Thursday, November 30, 2023, to complete the PY24 Recertification.

  • Spanish Cert/Recert will be launching later in the summer. More information coming soon.

Certification Links, Guides, Phone Numbers, Emails

Cigna Medicare Producer Certification Requirements for 2024

  • Details refer to certification for Cigna Medicare. AHIP certification must be completed separately.
  • Passing score is 85%. You have 3 attempts.

Cigna Medicare Certification Links, Guides, Phone Numbers, Emails

Cigna Medicare Producer Certification Requirements for 2024

  • Details refer to certification for Cigna Medicare. AHIP certification must be completed separately.
  • Passing score is 85%. You have 3 attempts.

Cigna Medicare Certification Links, Guides, Phone Numbers, Emails

BlueCross BlueShield of TN Producer Certification Requirements for 2024

  • Details refer to certification for BlueCross BlueShield of TN. AHIP certification must be completed separately.
  • More information coming soon!

BlueCross BlueShield of TN Producer Certification Requirements for 2024

  • Details refer to certification for BlueCross BlueShield of TN. AHIP certification must be completed separately.
  • More information coming soon!

Wellpoint Producer Certification Requirements for 2024

  • Details refer to certification for Wellpoint. AHIP certification must be completed separately.
  • Passing score is 90%.
  • 3 attempts.

Wellpoint Certification Links, Guides, Phone Numbers, Emails

Wellpoint Producer Certification Requirements for 2024

  • Details refer to certification for Wellpoint. AHIP certification must be completed separately.
  • Passing score is 90%.
  • 3 attempts.

Wellpoint Certification Links, Guides, Phone Numbers, Emails

Aetna Producer Certification Requirements for 2024

  • Details refer to certification for Aetna. AHIP certification must be completed separately.
  • The 2024 Individual Medicare Producer Certification for MA, MAPD, PDP and SNP launches on Wednesday, June 28, 2023

          Aetna Medicare will offer two certification options:

  • Aetna Medicare Compliance Training: Certifies producers to sell Aetna only (AHIP alternative)
  • AHIP Medicare Training: Certifies producers to sell for mulitiple carriers, including Aetna. 

 

Aetna Certification Links, Guides, Phone Numbers, Emails

Aetna Producer Certification Requirements for 2024

  • Details refer to certification for Aetna. AHIP certification must be completed separately.
  • The 2024 Individual Medicare Producer Certification for MA, MAPD, PDP and SNP launches on Wednesday, June 28, 2023

          Aetna Medicare will offer two certification options:

  • Aetna Medicare Compliance Training: Certifies producers to sell Aetna only (AHIP alternative)
  • AHIP Medicare Training: Certifies producers to sell for mulitiple carriers, including Aetna. 

Aetna Certification Links, Guides, Phone Numbers, Emails