Enhanced Direct Enrollment

The Center for Consumer Information & Insurance Oversight

Enhanced Direct Enrollment Resources for the Federally-facilitated Exchange

Welcome

This page provides information about Enhanced Direct Enrollment (EDE), and provides additional guidance and resources for web-brokers and issuers using or interested in this program. This page provides information about the EDE pathway in states that use HealthCare.gov to apply for and enroll in health coverage (states that use the Federally-facilitated Exchange [FFE], also known as the Marketplace, or State-based Exchange on the Federal Platform [SBE-FP] models). 

Introduction 

What Is Enhanced Direct Enrollment (EDE)?

Enhanced Direct Enrollment is a service that allows approved Qualified Health Plan (QHP) issuers and third-party web-brokers (online insurance sellers) to enroll consumers in Exchange coverage, with or without the assistance of an agent/broker, directly from their websites. It provides a comprehensive consumer experience including the eligibility application, Exchange enrollment, and post-enrollment year-round customer service capabilities for consumers and agents/brokers working on behalf of consumers, directly on issuer and web-broker websites. Through EDE, approved EDE Entities build and host a version of the HealthCare.gov eligibility application directly on their websites that securely integrates with a back-end suite of FFE application programing interfaces (APIs) to support application, enrollment and more. 
 

 

Enhanced Direct Enrollment Functionality and Capabilities

Consumers start their Exchange shopping experience by visiting the EDE entity website.
EDE entities can customize the consumer Exchange eligibility application (within guardrails) on their websites.
Consumers can return to the EDE entity website to update their application when information changes throughout the year and update their coverage if they’re eligible for a Special Enrollment Period (SEP) due to certain life events.
 
Consumers can upload documentation to resolve SEP Verification Issues (SVIs)/Data Matching Issues (DMIs) on the EDE entity website. The Exchange retains responsibility for reviewing and determining the outcome of DMIs or SVIs regardless of how consumers send in documents (i.e., EDE website upload, HealthCare.gov upload, or mailed in).
Consumers can view the status of their enrollment, SVIs, and DMIs on the EDE entity website.
Consumers can download Marketplace notices directly from the EDE entity website.
EDE entities own and manage all communications directly with the consumer (rather than via HealthCare.gov) wherever feasible.

How Do Issuers and Web-brokers Implement EDE?

Issuers and web-brokers can participate in EDE as a primary EDE entity, or as an upstream EDE entity. Primary EDE entities build the EDE platform, whereas upstream EDE entities leverage a primary EDE entity’s platform, usually with customized branding for the upstream entity. 

  • Primary EDE entities that build an EDE platform are required to integrate with a suite of more than 20 APIs that facilitate the eligibility, enrollment, and post-enrollment experience.
  • Primary EDE entities must undergo an extensive third-party audit of their EDE application and privacy/security structure, along with a CMS approval process and ongoing monitoring.
  • Upstream EDE entities that leverage a primary EDE entity’s platform, with only minor branding changes, are generally not subject to an audit of their application and privacy/security structure. However, if an upstream EDE entity wishes to make other deviations from an approved primary EDE entity's platform, the upstream EDE entity may also be subject to an audit. Upstream EDE entities that do not intend to build their own EDE pathway should refer to the list of approved EDE entities (PDF) to identify potential partners.

It is important to note that the Exchange retains responsibility for making eligibility determinations. The Exchange will communicate those eligibility determinations to the EDE entity via the EDE APIs, and the EDE entity will display the results to the user on the EDE entity’s website. 

In addition, the issuer will continue to receive its 834 enrollment transactions for all enrollments from the Exchange regardless of whether the enrollment is completed on an EDE entity website or on HealthCare.gov. (Note: 834 files aren’t sent to the primary EDE entity unless that entity is the actual issuer associated with the enrollments.) 

What Are the Options for Issuers and Web-Brokers to Participate in EDE?

At a high level, Entities may seek approval to participate in the EDE program as a: 

  • Primary EDE Entity that has developed its own EDE environment;
  • Upstream EDE Entity leveraging an approved primary EDE Entity’s EDE environment;
  • Downstream agent/broker using an approved primary or upstream EDE Entity’s EDE environment

Please note, some of these options may require developing a technical platform to interface with the Exchange, implementing and documenting privacy and security controls, and submitting documentation to CMS—including third-party audits—prior to being approved. For additional information on EDE program participation options and arrangements, see the EDE Auditor Guidelines linked below.

Prospective web-brokers are subject to an additional set of pre-approval requirements such as a pre-approval website review. Web-brokers must also provide license information and other related data elements (including the National Producer Number (NPN) of the web-broker’s designated representative that has completed Marketplace registration and training for the appropriate plan year for which the Web-broker Agreement is being initially countersigned or renewed) to CMS.

How Should Issuers and Web-brokers Initiate the EDE Onboarding Process?

Prospective EDE entities should take the following steps:

Approved EDE Entities List

The following document contains additional information on all approved EDE web-brokers and issuers approved use the enhanced DE pathway, including primary and upstream entities. Entities Approved to Use Enhanced Direct Enrollment (PDF)

Approved Web-broker Lists 

The FFE Direct Enrollment Web-broker List (PDF) contains the names of web-brokers participating in the FFE that have signed 2024 Web-broker Agreements with CMS and completed FFE registration for the 2024 plan year. CMS will update this list on a periodic basis.

Consumers may find information about certified enrollment partners in their state on HealthCare.gov at https://www.healthcare.gov/direct-enrollment.

Key Resources
Enhanced Direct Enrollment Guidance

Additional resources are available on CMS zONE, accessible via the CMS Enterprise Portal. New users must request access through the CMS Enterprise Portal. CMS zONE site access is restricted to participating web-brokers, issuers, and affiliated auditors only.

Direct Enrollment Help Desk

Please contact directenrollment@cms.hhs.gov with any questions regarding web-broker onboarding, DE and EDE policy, compliance, or operational questions.

 

 

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Page Last Modified:
09/30/2025 10:53 PM
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