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The Center for Consumer Information & Insurance Oversight

 

Resources for Agents and Brokers in the Health Insurance Marketplaces

Contents


Background

To the extent permitted by states, licensed agents and brokers may assist consumers in applying for qualified health plans (QHPs) and insurance affordability programs including premium tax credits and cost-sharing reductions. They play a crucial role in educating consumers about the Health Insurance Marketplaces, both during annual open enrollment and throughout the coverage year.

Some states have set up a State-Based Marketplace, while other states work with the federal government in a State-Partnership Marketplace or Federally-facilitated Marketplace (FFM). Agents and brokers can help consumers, no matter what state the consumers live in, as they apply for and choose insurance options. Agents and brokers who wish to participate in the FFM must first complete a two-part registration process (see “Registration for the Federally-facilitated Marketplace” below for more information on this requirement). This page contains resources for agents and brokers who are assisting individual market consumers in the Marketplaces, as well as small group market employers and employees in the Small Business Health Options Programs (SHOPs).


General Resources

Guidance

Regulations

News for Agents and Brokers

News for Agents and Brokers is an electronic source of information for Federally-facilitated Marketplace (FFM) agents and brokers. As with other communications to our Agents and Brokers, this monthly newsletter is disseminated electronically to Agents and Brokers on our e-mail listserv. We are committed to keeping agents and brokers informed about upcoming webinars/trainings, registration resources, relevant guidance and regulations, important announcements, and other useful information. Please take a moment to read the latest issue.

Application Posted for the Plan Year 2017 FFM Agent and Broker Vendor Training Program

The Centers for Medicaid & Medicare Services (CMS) is continuing the vendor training program for FFM agents and brokers for plan year 2017. Under this program, the Department of Health & Human Services (HHS) recognizes an agent’s or broker’s successful completion of a Marketplace training program from an approved vendor as sufficient to satisfy the requirement to receive training in the range of qualified health plan options and insurance affordability programs. Entities interested in developing and hosting FFM training for plan year 2017 must comply with all requirements outlined in 45 C.F.R. § 155.222.

Plan Year 2017 Vendor Application


The plan year 2017 vendor application is now available as a free fillable PDF via the link above. Prospective vendors must submit all application materials to CMS via email by 11:59 PM Eastern Time on February 19, 2016. For more information, please reference the Questions and Answers for the Plan Year 2017 Vendor Training Application. Any questions about the application process or the vendor training program should be directed to CMS at AgentBrokerVendor@cms.hhs.gov.

 

Plan Year 2016 Open Enrollment

Key Open Enrollment Resources

CMS hosted a webinar session on October 14 to provide an overview of FFM Open Enrollment for plan year 2016 as well as highlight new agent and broker support for plan year 2016. The session also provided tips on the “Find Local Help” feature on HealthCare.gov, tips from the Marketplace Call Center, information on working with Assisters and Navigators, and information on understanding the consumer. Lastly, the session covered periodic data matching and the process for ending qualified health plan coverage.

Plan Year 2016 Open Enrollment: A Primer for Agents and Brokers

CMS hosted two webinar sessions of the “Plan Year 2016 FFM Open Enrollment: A Primer for Agents and Brokers” on October 21 and 28. The webinar covered key information about plan year 2016 Open Enrollment, and provided an overview of the plan year 2016 FFM enrollment pathways, the Individual Marketplace online application, highlights on the SHOP Marketplace, and an overview of next steps for consumers who fail to file and reconcile advance payments of the premium tax credit (APTC) for plan year 2014. The webinar also reviewed the process to revoke the agent/broker role for agents and brokers who did not complete plan year 2016 FFM registration prior to the expiration of their plan year 2015 Agreements with CMS.

  • November 2015

Operational Updates and Announcements for Agents and Brokers Participating in the FFMs - Week 1 Slides

CMS hosted two webinar sessions on November 3 and November 5 to provide key Open Enrollment dates and reminders as well as information on how to prevent duplicate applications; the new provider lookup tool on HealthCare.gov, and resources for agents and brokers to use throughout Open Enrollment.

Operational Updates and Announcements for Agents and Brokers Participating in the FFMs – Week 2 Slides

CMS hosted two webinar sessions on November 10 and November 12 to provide key Open Enrollment dates and reminders as well as information on how to ensure National Producer Numbers (NPNs) are retained on renewals for plan year 2016; guidelines for agents and brokers working with assisters and Navigators; and responses to key agent and broker FFM registration, training, and eligibility questions.

Operational Updates and Announcements for Agents and Brokers Participating in the FFMs – Week 3 Slides

CMS hosted a webinar session on November 17 to provide key Open Enrollment dates and reminders as well as tips for assisting consumers with multi-tax households; information on how to ensure National Producer Numbers (NPNs) are retained on renewals for plan year 2016; instructions on how to search for an existing application; and responses to key agent and broker questions on FFM registration and training and the SHOP Marketplace.

Operational Updates and Announcements for Agents and Brokers Participating in the FFMs – Week 4 Slides

CMS hosted a webinar session on November 24 to provide key Open Enrollment dates and reminders as well as information about the new HealthCare.gov Prescription Drug Check feature; information on the use of mailings and email addresses by agents and brokers; updates on marketing opportunities with the Marketplaces; information on the designated market areas with the highest numbers of uninsured; and highlights of proposed Marketplace policies impacting agents and brokers from the proposed 2017 Payment Notice.

  • December 2015

Operational Updates and Announcements for Agents and Brokers Participating in the FFMs – Week 5 Slides

CMS hosted a webinar session on December 1 to provide key Open Enrollment dates and reminders as well as information on the cut-off dates for plan year 2015 special enrollment periods and changes in circumstance; highlights from the proposed 2017 Payment Notice; tips for reminding consumers of their rights; a walkthrough of the new Prescription Drug Check tool; tips for consumers on Marketplace qualified health plan deductibles; and an overview of catastrophic plans.

Operational Updates and Announcements for Agents and Brokers Participating in the FFMs – Week 6 Slides

CMS hosted a webinar session on December 8 to provide tips from the Marketplace Call Center on assisting consumers; information on transitioning Consumer Operated and Oriented Plan (Co-op) Program enrollees for issuers ceasing to offer Marketplace plans; information on marketing opportunities for agents and brokers; information on the cut-off dates for plan year 2015 special enrollment periods and changes in circumstance; an overview of the income and household size  eligibility criteria; and a summary of how to become a web-broker in the FFMs.

Operational Updates and Announcements for Agents and Brokers Participating in the FFMs – Week 8 Slides

CMS hosted a webinar session on December 22 to provide updates on the December 15, 2015 Open Enrollment deadline extension, an overview of the Marketplace Application checklist, information on the SHOP Marketplace minimum participation requirement, an overview of SHOP Marketplace health and dental coverage options, a snapshot of Marketplace affordability for the FFMs for plan year 2016, and a walkthrough of the new Facility Lookup feature.

Operational Updates and Announcements for Agents and Brokers Participating in the FFMs – Week 9 Slides

CMS hosted a webinar session on December 29 to provide updates on Marketplace affordability for the FFMs for plan year 2016, highlights on marketing opportunities for agents and brokers, a walkthrough of the new Facility Lookup feature, tips on how to simplify the steps for staying covered through the Marketplaces to consumers, highlights on new research on small employers and the SHOP Marketplaces, information on the SHOP Marketplace minimum participation requirement, an overview of SHOP Marketplace health and dental coverage options, and information on the requirements for Privacy Notice Statements.

  • January 2016

Operational Updates and Announcements for Agents and Brokers Participating in the FFMs – Week 10 Slides

CMS hosted a webinar session on January 5 to provide reminders on key Open Enrollment dates and tips from the Marketplace Call Center on assisting consumers, highlighting important information on assisting consumers in preparation for the 2015 tax season, and reporting personally identifiable information breaches.

Operational Updates and Announcements for Agents and Brokers Participating in the FFMs – Week 11 Slides

CMS hosted a webinar session on January 12 to review the agent/broker responsibility to take reasonable steps to ensure their consumers are providing accurate information to the Marketplace, information about the draft 2017 Letter to Issuers in the FFM, and to provide highlights about new research findings on small employers and the SHOP Marketplace.

Operational Updates and Announcements for Agents and Brokers Participating in the FFMs – Week 12 Slides

CMS hosted a webinar session on January 19 to highlight progress enrolling consumers for plan year 2016, provide tips on how to “close the deal” with clients before the end of Open Enrollment and for staying in touch after Open Enrollment ends, review what consumers need to know for tax season and how agents and brokers can help, provide information on health coverage exemptions available to consumers, and review the requirements for recording consumer consent and the restrictions for naming a business or website.

Marketplace Frequently Used Terms – Spanish

A glossary of the most frequently used Health Insurance Marketplace terms in Spanish. You may find this tool useful when enrolling Spanish-speaking clients.

Registration for the Federally-facilitated Individual Marketplace (FFM) and the Small Business Health Options Program (SHOP) Marketplace

Plan Year 2016 FFM Registration and Training NOW LIVE

Plan year 2016 FFM agent and broker registration and training is now available on the CMS Enterprise Portal at https://portal.cms.gov. Training is offered by CMS on the new Marketplace Learning Management System (MLMS) in English and Spanish, as well as through the CMS-approved vendors listed here in English.

For information on how to complete FFM registration and training for plan year 2016, see below.