Lesson 4: ACA Enrollment Technology

Hi, I’m Mark with Agent Elevate. Here in this lesson to talk to you about the federally facilitated marketplace, also known as FFM or Healthcare gov. In my ten years of experience in the insurance industry with ACA, I’ve commonly talked to agents about the healthcare gov and some of its ins and outs and some of the better perks of it. And let’s go ahead and dive into that for a little bit further knowledge.

 A public system created in 2013 and operated by Centers for Medicare and Medicaid Services, also known as CMS, that is utilized for the implementation of ACA plans and services to those individuals and small businesses needing qualifying health coverage. It works in conjunction with Medicaid Children’s Health Insurance Program, or Chip, commonly referred to and premium tax credits or APTC for the annual premium tax credit. There are currently 18 state-based marketplaces, three state based marketplaces using that federal platform masked over and 30 using the actual FFM.

Now, the FFM allows shopping for health plans by metal tier, as you’ve probably learned. You’re going to learn in these lessons and evaluates enrollees for subsidies to assist in the premium payment of qualifying health plans. The core functions of the marketplace being eligibility and enrollment determines the amount of subsidy offered to a client as a discount to their premium based on their household income and facilitates the enrollment into a certified plan available in the client’s local market via real time verification. Also used for plan management or qualifying health plans only CMS certified plans only CMS monitoring and oversight, account management and recertification, small business health option plans for any of those businesses with one to 50 employees can accomplish tax credits or subsidies for assistance with group premiums. Financial management coordination between carriers in the marketplace for premium binder payments. Federal tax implications from subsidy evaluations, for consumer support as well in the helping of purchasers determine eligibility and apply for a health plan via the marketplace. 24 hours call center that consumers can use to apply for coverage themselves as well.

Now, some of the enrollment tool options out in the market as well being Enhanced Direct Enrollments, Healthcare.gov being the backbone of those. Still, it’s more of a mask over to help with speed and ease of use, but we’ll get into that a little bit further too. And you could also go for off exchange plans through the personal portal on each individual carrier. Now, Health Sherpa being a prominent enhanced, direct enrollment or EDE platform. It’s a third-party Healthcare gov approved partner. They work in conjunction with them to mask over and help you with speed of use and much better feel for the client and for yourself as the agent.

Easy way to quote, enroll and compare plans. Enroll submit follow ups and track statuses. The speed of use being first and foremost in the actual usage of the platform. Built in Client Resource Manager or CRM, betterly known as for easy upload and download of client list, and you also have marketing options to include Drip marketing in there as well. They do offer referral programs on most platforms such as this, so that you can still maximize on those clients.

Say you’re contracted in Texas and not able to sell in Nebraska or not licensed there yet. Taking a little bit too much time and you’re up against the grind. You probably need to go ahead and refer that over, get that client taken care of now to give you that opportunity to get set up later.

Post enrollment, you see status upload, documentations on any changes of income, anything else that may affect that subsidy, or some of the options they may be presented, binder payments and report changes or change plans altogether. These are all FFM state quoting options. If you’re in a state-based state, you must use their quote and enroll tools.

 Now that you’ve learned about healthcare.gov, the Federally Facilitated Marketplace, and some of the enhanced direct enrollment options available to you, let’s go ahead and take a brief quiz to test that knowledge out before we kick it over to Brandon on how to get you started selling.