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Consumers may experience many changes throughout the year. Application edits and updates are often needed when a consumer experiences changes.
In this article we’ll cover:
Edit application functionality is not available within HealthSherpa Enrollee Assistance Full-Service account types.
Why updates matter
Consumers are responsible for keeping their Marketplace application up to date throughout the year.
Consumers may need to update the application when household circumstances change or when a Qualifying Life Event (QLE) occurs.
If the application is out of date, eligibility results may be inaccurate. This can lead to an incorrect subsidy amount, which may impact what the consumer pays each month and what they may need to reconcile when they file federal taxes.
How to edit an application
With consent, agents can assist consumers with application updates.
The Clients page contains consumers connected to the HealthSherpa account who have successfully submitted an enrollment.
Using HealthSherpa, agents can assist consumers with making application updates if the consumer is already listed on the Clients page. To assist a consumer who is not already on the Clients page, with consent, agents can search & claim the consumer’s existing application.
Step 1: Open the consumer record
Step 1: Open the consumer record
To assist a consumer who is already listed on the Clients page, select the consumer’s name to open their consumer record.
The Details tab is the default view when an agent opens a consumer record from the Clients page.
Agents can only service an application if they have an active Enhanced Direct Enrollment (EDE) connection to the application.
The Centers for Medicare & Medicaid Services (CMS) grants EDE permission to agents for an enrollment submission. This permission enables data syncs between the Marketplace and HealthSherpa.
If EDE connection is disrupted, with consent, agents can search & claim the consumer’s existing application to reestablish the EDE sync.
Step 2: Open the application for editing
Step 2: Open the application for editing
From the Details tab, select Edit app located at the top of the page, then select Edit application from the drop-down menu.
You may also select View application from the Application section.
Agents are prompted to view or edit the application. Select Edit next to the first section that needs updates.
Continue through the application to make additional updates as needed.
Step 3: Resubmit the application
Step 3: Resubmit the application
After updates are complete, resubmit the application.
After the application is resubmitted, updated eligibility results will process and HealthSherpa will prompt the agent to download the eligibility letter. Select Review plan to continue.
Step 4: Confirm selections
Step 4: Confirm selections
On the Confirm your plan page, document updated consent as needed.
If updates made to the application do not open an enrollment period or the consumer does not want to change plans, select Enroll in this plan to finalize the application updates.
If updates made to the application open an enrollment period and the consumer wants to shop for a different plan, select Change plans to return to plan results.
Common examples of updates needed
When consumer information or circumstances change during the year, the Marketplace application often needs to be updated.
Common examples of Marketplace application updates needed include:
Updating income
Updating income
Adding an applicant
Adding an applicant
Removing an applicant
Removing an applicant
Frequently asked questions
What are enrollment periods?
Enrollment periods determine when consumers can enroll in Affordable Care Act (ACA) coverage or change ACA plans. Outside of Open Enrollment, a consumer typically needs a Qualifying Life Event (QLE) to qualify for a Special Enrollment Period (SEP).
Are there subsidy payback limits?
When a consumer files their federal tax return, the Internal Revenue Service (IRS) compares the advance premium tax credit (APTC) paid on their behalf during the year to the premium tax credit they are actually allowed based on their final tax return information. This is known as reconciling APTC.
For plan year 2025: If the APTC paid on the consumer’s behalf during the year is more than the allowed credit on the consumer’s tax return, the consumer may have to repay some or all of the difference, subject to certain repayment caps (also known as payback limits). If the allowed credit is more than the APTC paid, the difference may increase the refund or reduce the balance due.
Beginning in plan year 2026: There is no limitation on excess APTC that consumers must repay when filing their tax return and reconciling their APTC. If the allowed credit on the tax return is different than the APTC paid on the consumer’s behalf during the year, the difference may increase the refund or reduce the balance due.
Additional resources
For help using HealthSherpa or for other assistance, contact Agent Support. Agent Support is available by phone at (888) 684-1373, by email at Agent_Support@HealthSherpa.com, or by chat directly from your account.
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