Under-65 health insurance sales aren’t nearly as regulated as Medicare sales; however there are some rules agents selling Affordable Care Act (ACA) insurance must follow. It’s important that you meet these requirements to maintain compliance.
As a result of the 2024 Marketplace Final Rule, there are new requirements for agents who sell 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.
All agents who complete marketplace sales must be licensed, certified, and appointed to sell insurance products to be ready-to-sell.
Agents must be a licensed agent or broker with an approved, active, and health-related line of authority (LOA) in their resident state that also states where their clients reside. After completing licensing requirements, agents can become certified to sell marketplace products by completing the 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.
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).
If you’re an agent selling ACA plans in a state-based marketplace (SBM), you’re also required to complete training or certification, but it must be completed through the state. Find the marketplace in your state here.
Each year we cover training deadlines and what changes have taken place in all of the marketplaces Ritter supports. Read our post
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 that you are held liable for properly representing a carrier and their product.
Collect Consumer Authorization
The 2024 Marketplace Final Rule dictates that, as of June 18, 2023, 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 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.
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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 applications, 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.
Changes occur often in the insurance industry, and Ritter wants to make sure that 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 requirements.