SEP Success – ACA 101

Episode Summary

The Affordable Care Act (ACA) provides opportunities for health insurance agents to assist clients with enrolling in qualified health plans, even outside of the regular annual open enrollment period. There are special enrollment periods that allow eligible people to sign up for ACA coverage after certain qualifying life events.

In this podcast, the host explains what the ACA special enrollment period entails. He notes that agents can market and sell ACA marketplace plans year-round to people who have experienced triggering events like losing employer-based health insurance, moving to a new home, getting divorced, having a baby, or income changes.

To take advantage of this opportunity, agents need to get certified to sell ACA plans. This includes having a valid insurance license, errors and omissions liability coverage signed carrier appointment contracts, and completing all CMS training requirements. It is also essential for agents to build relationships and trust with local underserved communities by regularly attending events and explaining how the ACA can make coverage more affordable.

When meeting with potential clients, agents should outline the types of medical plans available on the ACA marketplace, such as HMOs, PPOs, EPOs, and high-deductible options. They need to explain how premium tax credits and cost-sharing reductions can significantly lower overall healthcare costs for lower-income households. Before assisting anyone with enrollment, agents must have them complete consent forms and be vigilant about income verification, employer coverage coordination, and potential data matching issues to avoid problems.

The host stresses that while selling ACA plans takes work, it can be rewarding for agents in both commission income and the ability to get more individuals insured during major life changes. He advises that agents focus on guiding clients through the process smoothly, reporting any instances of application fraud, and helping resolve data issues that could jeopardize tax credits. With the right expertise and focus, agents can succeed in this space while making a difference in people's lives.


(0:00:00) - Broker Link podcast focuses on helping insurance agents sell during ACA special enrollment
(0:00:50) - There are millions of uninsured people and a lot of these people don't shop
(0:02:05) - Your qualified health plans meet the rules of the Affordable Care act
(0:04:22) - All of the plans on the marketplace are qualified health plans
(0:09:36) - The majority of plans we're seeing these days are HMOs
(0:13:08) - To get started selling insurance, you need errors and omissions insurance
(0:16:49) - SCP special enrollment period is outside of open enrollment period
(0:18:58) - SCP is someone who has had a loss of qualified health plan coverage
(0:22:25) - Not everything that people want to call a special enrollment period qualifies
(0:30:21) - Cost-sharing reductions can lower your deductible and your max out of pocket
(0:33:31) - CMS requires a consent form for anyone helping you enroll in coverage
(0:37:54) - Understanding risk and value when you're selling health insurance is important
(0:40:46) - To be eligible to enroll, you must live in the United States
(0:46:34) - One of the things that you will encounter when doing these things is data matching issues

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