Agent Requirements for ACA Sales

Under-65 health insurance sales aren’t nearly as regulated as Medicare sales; however there are some rules Affordable Care Act agents must follow. It’s important that you meet these requirements to maintain compliance.

As a result of the 2024 Marketplace Final Rule, there are certain requirements for agents who sell Affordable Care Act (ACA) insurance plans. We’ll discuss all the ACA sales rules you need to meet to be ready-to-sell during and outside of the Open Enrollment Period (OEP). Additionally, we’ll provide tools to make things easier for you when enrolling clients.

Become Ready-to-Sell

All agents who complete marketplace sales must be licensed, certified, and appointed to sell insurance products to be ready-to-sell.

Licensing Requirements

Agents must be a licensed agent or broker with an approved, active, and health-related line of authority (LOA) in their resident state, as well as any other state where they wish to sell. After obtaining their license(s), agents can become certified to sell marketplace products by completing the additional requirements.

Certification Requirements

Every agent who sells ACA plans must be certified. If you’re selling in the federal marketplace, you must complete the Federally Facilitated Marketplace certification. This certification is available for free through the Centers for Medicare & Medicaid Services (CMS). Agents who are completing the FFM certification for the first time will need to take the full version of the training, whereas agents who have previously sold marketplace plans in the year prior can take a condensed version of the training. Completing the FFM certification allows an agent to sell in all FFM states.

If you’re selling in the federal marketplace, you must complete the Federally Facilitated Marketplace certification. This certification is available for free through CMS.

If you’re an agent selling ACA plans in a state-based marketplace (SBM), you’re also required to complete that state’s specific training or certification. Find the marketplace in your state here.

Appointment Requirements

You must obtain an appointment with the carriers whose products you are selling in the state that you are selling them in. A carrier appointment is the agreement in which you are held liable for properly representing a carrier and their product.

Ritter agents have access to Contract Now within the Ritter Platform, which simplifies the entire contracting process. If you haven’t already, sign up with Ritter for free and speak with your sales specialist to gain access to Contract Now!

Collect Consumer Authorization

The 2024 Marketplace Final Rule dictates that agents must document a client’s authorization to receive assistance with their ACA coverage decisions. Agents must obtain this consent before assisting a client with enrolling in a plan. The only marketplace requirements of this documentation specified by CMS are that agents must document the date consent was given, the name of the consumer or their authorized representative, and the name of the agent, broker, or agency being granted consent. Additionally, agents must keep this documentation on file for a minimum of 10 years and be able to produce it whenever asked by the marketplace.

Agents must keep client authorization on file for a minimum of 10 years and be able to produce it whenever asked by the marketplace.

ACA consumer authorization may be collected in writing, via email, or by a recorded telephone call. These are all acceptable methods for documenting consent. Ritter has created a form for agents to use when collecting client authorization. This form complies with CMS requirements and is easy to use. Agents can also collect consent via a recorded call. We have created a script for agents to use while on the phone with clients to collect and record authorization.

Clients are allowed to rescind their consent for assistance at any time. This requirement seeks to minimize disputes between clients and parties that may have been acting on their behalf without client authorization or awareness.

Collect Consumer Eligibility Attestations

As of June 18, 2023, agents must also document a client’s attestation that eligibility information has been reviewed and confirmed to be accurate on their application. CMS requires agents to collect the eligibility attestation before submitting the application. This document must include the date the information was reviewed by the client, the name of the client or their authorized representative, an explanation of the attestations at the end of the eligibility application, and the name of the agent or broker.

CMS requires agents to collect the eligibility attestation before submitting the application.

As with consumer consent, agents must also maintain this documentation for 10 years and be able to produce this whenever asked in case of an audit. Agents may collect attestations using whichever format their client feels comfortable with. To assist agents with this requirement, we’ve created a form and an accompanying call script. CMS recognizes eligibility attestations that were collected in writing, via email, or via recorded telephone calls.

Eligibility attestations are required to reduce the number of customer complaints about inaccurate or incorrect enrollment information. By confirming that enrollment information is correct, the process to receive coverage should be smoother and more convenient for clients.

Identify and Report Suspicious Activity

As an agent tasked with protecting consumers’ personal information, it’s your responsibility to speak out if you notice suspicious activity or fraudulent behavior. Recently, there have been reports of unauthorized plan switching or activity on some marketplace accounts. Marketing call centers have been influencing consumers to change their plans by offering cash or savings. As a marketplace agent, you’re responsible for acting in your clients’ best interest and protecting their information. You can notify the Marketplace Call Center of unauthorized activity at 1-800-318-2596 (TTY: 1-855-889-4325). Not only is it the right thing to do, but if you don’t, you could also miss out on commissions!

Changes occur often in the insurance industry, and Ritter wants to make sure you’re aware of everything that may impact the way you do business. We’re committed to developing resources that make it easier to maintain a compliant business practice and stay on top of new insurance agent requirements.

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