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This article answers frequently asked questions (FAQs) from agents

Yes. Browser search tools can be used.

This opens a search bar to find words or phrases on the page.

An NPN is a National Producer Number. It is a unique number assigned during the licensing application process. The NPN is used to identify licensed agents across states and systems. Licensed agents can look up their NPN at any time if needed.

As an ACA agent or broker, you will create your Federally-facilitated Marketplace (FFM) user ID when you complete the FFM registration process through the Centers for Medicare & Medicaid Services (CMS) Enterprise Portal for the first time.

You are required to have your own unique FFM user ID. CMS does not allow agents to share credentials.

To recover your FFM user ID, you will need to return to the CMS Enterprise Portal and follow the prompts on the ‘Forgot User ID’ page. After submitting accurate information, an email containing your user ID will be sent to the email address on your profile. If you run into any trouble with this recovery process, you can reach out to the Marketplace Service Desk at CMS_FEPS@cms.hhs.gov or CMS broker support at 855-267-1515 for help.

CMS does not allow you to have more than one FFM user ID. If you are having trouble accessing your account, contact CMS.

Not necessarily. Certification required can vary by state and is often determined by the type of marketplace used in the the state. Reference this article to learn more.

The term exchange simply refers to the Marketplace - the federally facilitated marketplace or a state-based exchange, respectively. Off-exchange plans are not eligible for subsidies and may be purchased without completing a subsidy application via the Marketplace. On-exchange plans may be eligible for subsidies and require a subsidy application be completed in addition to the plan selection. The quantity and plan options available may vary when shopping on-exchange vs off-exchange, however, on-exchange and off-exchange plans cover the same essential health benefits required by the ACA (if ACA-compliant).

No, customers who know they are not subsidy eligible may still shop for on-exchange plans.

If your consumer is certain they will not be subsidy eligible, but does want to shop on-exchange policies, they may simply answer ‘no’ to the question within the subsidy application that asks “would you like to see if you’re eligible for cost savings.”

However, it is usually a good idea to answer “yes” to this question and fill out the eligibility application to be sure. If your consumer’s circumstances change later in the year and they become eligible for a subsidy, they may be eligible for a refund when they file taxes for the months they did not receive a subsidy.

Binder payments are often due by the plan's effectuation date, but can vary carrier to carrier as well as by qualifying life events (i.e. Special Enrollment Periods). Consumers should check with their insurance carrier regarding binder payment deadlines to ensure their plan effectuates.

Narrowing down plan options can feel overwhelming to a consumer. As their licensed agent, consider asking questions that help you identify how the consumer plans to use their coverage. Perhaps questions such as:

Healthcare.gov defines these terms and more in this glossary

CMS requires an SSN on the application for the primary applicant & anyone applying for coverage. Agents assisting non-U.S. citizens who do not have an SSN but do have qualifying immigration status will be able to enter immigration document details instead.

Entering an SSN/immigration documentation is strongly recommended for any non-applicant household members as well because excluding their information will likely generate an Income related Data Matching Issue (DMI) that requires documents be uploaded to prove income. This is because CMS uses even non-applying tax household members' income to determine subsidy amounts.

HealthSherpa has the list of what to include and exclude when considering income built into the subsidy application for your ease of reference. You can also view the full breakdown of what’s included as income here.

Yes, you’ll want to include any income a consumer may have already earned during the year.

Should their anticipated income change later in the year (perhaps they get a new job, etc.), they may simply update their income information at that time.

This question refers to the subsidy application itself. Per Healthcare.gov “Agreeing to this statement allows the Marketplace to use available income information from the IRS for up to 5 years for renewing your [subsidy] application. If you enroll in coverage through the Marketplace, we want to help you keep your coverage. One way to do that is to allow us to check electronically available income data to make sure you’re still [subsidy] eligible, instead of asking you to prove that your income still qualifies…Selecting this option may impact your ability to get help paying for coverage at renewal or require you to provide more information.”

You can learn more about other agreement questions here.

Consumers may need to pay back the difference between the amount of advanced premium tax credits used and the final amount a consumer is found to have been eligible to receive during a given tax year. Healthcare.gov elaborates on this here.

One thing to keep in mind is that, depending on current legislation, there could also be dollar caps on the amount of repayment dollars potentially owed. Here is some information on those repayment limits for tax year 2024.

It’s critical that consumers ensure their subsidy application always reflects the most accurate information possible throughout a plan year. Consumers can update their subsidy application any time by contacting you, their agent, or by logging into their subsidy application directly to report changes.

Keeping the toggle set to “Mine” will allow you to view clients and leads under your HealthSherpa account. Sliding the toggle to “Shared” or “Agency” will allow you to see additional clients and leads that may belong to other agents in your agency.

If you see filters on your clients and leads tabs that allow you to toggle between “Mine” & “Agency” or “Mine” & “Shared,” then your agency administrator has enabled these intentionally.

Empower your consumer’s to self-service. Every client that's enrolled through HealthSherpa receives an invitation to log in to their very own consumer dashboard. From the consumer dashboard, client’s can view their plan details, upload their own follow-up documents, view notices from the Marketplace (like 1095-A forms), and even report changes to their application. Full details can be found here.

Consumers can cancel their plan during the year for various reasons. View step-by-step instructions here to ensure the correct path is followed for their unique circumstance.

CMS covers these in depth on page 26 here.

A passive enrollment takes place when a consumer does not make an active re-submission and plan selection prior to the December 15th deadline. In a passive enrollment, CMS will automatically re-enroll that individual in either the same plan or an alternate plan selected by the FFM effective 1/1.

An active enrollment takes place when a consumer actively participates in re-submitting their application and plan selection for the upcoming plan year.

No. You can help consumers throughout the year as long as they have a Qualifying Life Event. Learn more about Qualified Life Events (QLEs) here.

SEPs are certain timeframes outside of OEP when a client can enroll in an ACA plan. This timeframe is triggered by a QLE. Learn more about Qualified Life Events (QLEs) here.

Effective dates for consumers with SEPs are determined by the specific QLE that has taken place. Some SEPs state coverage starts on the first of the month after plan selection, while other SEPs offer an effective date of coverage that retros back to the date of the QLE, and others offer an effective date appropriate to the unique circumstances of the consumer.

The enrollment window for customers to apply for coverage outside of open enrollment is determined by the specific QLE that has taken place. Learn more about Qualified Life Events (QLEs) here.

Not necessarily, but customers will typically need to be able to provide alternative documentation in those instances. The full list of documentation is available here.

Customers may be eligible for an SEP if they or others in their household had Medicaid/CHIP, but recently lost it; have Medicaid/CHIP, but will lose it soon; applied for Medicaid/CHIP recently, but were denied; and possibly other scenarios. Full details on the scenarios can be found here.

‘Medicaid eligible’ on the quoter does not necessarily mean the parties on the quote will be found Medicaid eligible.

‘Medicaid eligible’ on the subsidy eligibility notice typically indicates that someone on the application may be eligible for Medicaid. If a person is found eligible for Medicaid/CHIP on an eligibility notice, the marketplace will automatically send the customer’s information to the respective state agency who will contact the consumer about potential enrollment. Customers can also apply directly through their state Medicaid agency as outlined here.

‘Medicaid eligible’ on the subsidy eligibility notice typically indicates that someone on the application may be eligible for Medicaid. If a person is found eligible for Medicaid/CHIP on an eligibility notice, the marketplace will automatically send the customer’s information to the respective state agency who will contact the consumer about potential enrollment. Customers can also apply directly through their state Medicaid agency as outlined here.

CMS explains this in depth here. In short, the default is an effective date on the first of the following plan selection after the Medicaid/CHIP ineligibility determination. However, they may conduct a three-way call with the Marketplace Call Center to ask for a retroactive effective date back to the date coverage would have started if the Marketplace had not initially routed the case to Medicaid/CHIP. This is usually granted when a customer has already completed a Marketplace application but was initially determined to be Medicaid eligible at the time of application.

If you have questions for CMS, please reach out to the CMS Agent Broker (AB) help desk. The CMS Agent Broker Help Desk can be reached by calling 1 (855) 267-1515 or by emailing FFMProducer-AssisterHelpDesk@cms.hhs.gov.

Additionally, CMS provides a list of useful resources for ABs here.

CMS provides information on the Help Desks available to agent working within the Federally-Facilitated Marketplace (FFM) here. CMS also provides a list of useful websites for brokers here.

HealthSherpa is accessible through all web browsers but is most optimized for Google Chrome and Firefox. HealthSherpa is functional on both Macs and PCs, and optimized for different screen sizes.

There are a few items that could impact a premium amount compared to what the client was originally quoted:

If you notice a large disparity in what was quoted on our website versus what is quoted on Healthcare.gov, please let our Agent Support team know by giving us a call at 888-684-1373 or emailing us at agent_support.com so that we can investigate and the issue.

For individuals who are offered employer coverage, whether they’re able to get a subsidy depends on whether what is offered by their employer is considered “affordable.” Specifically, their employee contribution towards employer-sponsored health coverage must be less than 8.39% of their household income (as of 2024; this number changes every year, so be sure to double check the current calculation).

Prior to the 2024 Open Enrollment period, if a worker’s individual coverage offer was considered affordable, the entire family was considered to have “affordable” employer coverage — even if adding a spouse or kids to the plan drove up the price way above the 8.39% threshold. This was called the Family Glitch and affected millions of people nationwide. Thankfully, new rules mean that if the coverage for the individual worker is under the threshold, but coverage for the household exceeds 8.39% of household income, other household members are considered not to have an affordable offer of coverage and can shop for coverage with subsidies.

Individuals and agents who use HealthSherpa to shop and apply for coverage are asked a series of questions to help them find subsidies and plans to meet their needs. Part of the application process includes questions that assess whether or not workers’ offers of individual and family coverage are affordable. When using HealthSherpa to apply for a client who is offered employer-sponsored coverage, be sure to have the employee-only and the family cost of coverage available to ensure you can get an accurate subsidy determination. You will need that information to enter into the Employer Sponsored Coverage section of the user flow as seen below:

Please note, HealthSherpa quoting does not calculate whether their contribution is found affordable or not. You will need to complete the application to determine available subsidies.

For more information, please see Healthcare.gov’s explanation of the rules.