Welcome to the Agents and Brokers Resources webpage. This page is the primary outlet for agents and brokers to receive information from CMS about working in the Health Insurance Marketplace and the Small Business Health Options Program (SHOP).
To the extent permitted by states, licensed agents and brokers may assist consumers determine their eligibility for insurance affordability programs, including advance payments of the premium tax credit and cost-sharing reductions, and enroll them in qualified health plans (QHPs).
Agents and brokers play a crucial role in educating consumers about the Health Insurance Marketplace, both during annual Open Enrollment and throughout the coverage year. Agents and brokers may also help employers understand their options for enrolling in SHOP coverage and assist them and their employees through the SHOP application and enrollment process.
Some states have set up their own State-based individual and small business Marketplaces, while the federal government runs the Individual Marketplace through HealthCare.gov and/or SHOP in other states. You can find out if a state is running its own Marketplace by visiting HealthCare.gov and selecting the state from the drop-down list. Agents and brokers can help consumers apply for and choose insurance options in any state in which the agents and brokers have an active state license that is approved for a health-related line of authority, regardless of whether the Marketplace is operated by the state or federal government.
Agents and brokers who wish to assist consumers in the Individual Marketplace on HealthCare.gov and/or SHOP must complete registration and required training on an annual basis—prior to assisting consumers enroll in a plan.
Plan year 2019 Marketplace registration and training for agents and brokers is now available on the Centers for Medicare & Medicaid Services (CMS) Enterprise Portal!
For more information and resources on registration and training, visit the Plan Year 2019 Registration and Training page.
The Centers for Medicare and Medicaid Services (CMS) is continuing the vendor training program for Marketplace agents and brokers for plan year 2020. 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.
The Vendor Application is to be completed by entities requesting approval to host Federally-facilitated Exchange (FFE) training for agents and brokers for the 2020 plan year. Entities interested in hosting Marketplace training for plan year 2020 must comply with all requirements outlined in 45 C.F.R. § 155.222. Final approval for any vendor is contingent on signing an Agent Broker Vendor Agreement with CMS, approval of vendor’s final training content, approval of vendor’s information technology and data storage processes, adequate technical support, and compliance with applicable system standards and other regulatory requirements, including the requirement to offer continuing education units in at least five FFE or State-based Exchange on the Federal Platform (SBE-FP) states.
The plan year 2020 vendor application is now available. Prospective vendors must submit all application materials to AgentBrokerVendor@cms.hhs.gov via email by 11:59 PM Eastern Time on January 7, 2019. Incomplete applications will not be reviewed and the applicant will be denied. For more information about the vendor training program and application process, please reference the Questions and Answers for the Plan Year 2020 Vendor Training Application. All questions and application materials should be directed to CMS at AgentBrokerVendor@cms.hhs.gov.
Help On Demand is a real-time consumer assistance referral system operated by BigWave Systems that connects consumers seeking assistance with Marketplace-registered, state-licensed agents and brokers in their area who can provide immediate assistance with Marketplace plans and enrollments. The Help On Demand technology is hosted by BigWave Systems. Only agents and brokers who have completed Marketplace training and registration are eligible to participate in Help On Demand. For more information and resources on Help On Demand, visit the Help On Demand page.
CMS is planning a series of upcoming webinars to help you assist consumers after the Open Enrollment period ends. More details on the content and registration for these webinars will be available soon on REGTAP.
Agents and brokers can now choose the types of emails they want to receive from the Marketplace by updating Subscriber Preferences. Click here to find out how. To get started:
News for Agents and Brokers is an electronic source of information for agents and brokers assisting consumers in the Marketplaces on HealthCare.gov. Check out the latest edition here.
For a collection of notices including Eligibility, Special Enrollment Period Pre-enrollment Verification, Cross-Issuer, Data Matching, and Account Transfer notices, visit the Marketplace Notices webpage.
When helping consumers enroll in health coverage, the Marketplace may ask for documents to confirm information on the application. Agents and brokers can access more information regarding how to submit documents online or by mail by clicking here.
The Affordable Care Act includes the individual shared responsibility provision and the premium tax credit that may affect your clients’ tax returns. For more information on Affordable Care Act Tax Provisions for Individuals and Families, click here.