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Plan shopping allows agents to quote and compare plans and review plan results with a consumer. Agents can start plan shopping at any time by getting a quote or land on plan results after completing the subsidy application.

In this article we’ll cover:

Agents can start plan shopping at any time by clicking Quote On-Ex to open the quoter.

A drop down menu may display if Off-Exchange medical plans or Off-Exchange dental plans are available within the HealthSherpa account. Selecting either of these options within the Quote drop-down menu opens a different quote flow than the On-Exchange flow described in this article.

With consent, enter the consumer’s ZIP code, date of birth or age, gender, and household information into the quoter.

Add additional people to the quote if needed, then view estimated subsidy eligibility.

Premiums and subsidy eligibility shown during quoting are estimates. Final eligibility for coverage & financial assistance is determined by the Marketplace after the consumer completes the subsidy application.

Review available plans with the consumer and narrow options based on the consumer’s needs.

Plan results display below the quoter after the consumer’s information is entered. Agents may also land on the plan results page after completing the subsidy application.

To review a plan in more detail, click Plan details on the plan card. When available, the Plan details page also includes official carrier documents, such as the drug formulary & provider directory.

Plan results can be filtered to narrow options based on the consumer’s needs. Start by identifying the consumer’s priorities, such as provider preferences, prescription usage, budget, and how they expect to use coverage.

From plan results, agents can save a quote, share plan options with a consumer, or compare plans side by side.

Plan shopping and the subsidy application are distinct parts of the flow that culminate in an enrollment submission. Enrollment submission can begin with plan shopping or with completing the subsidy application.

Select Enroll or Enroll now on a plan card to continue with the enrollment submission flow.

Consumers who start plan shopping or start an application but have not submitted an enrollment display on the Leads page. After an enrollment is successfully submitted, the consumer moves to the Clients page.

During the Open Enrollment Period (OEP), use the available renewal pathways to assist consumers who are already on the Clients page. To assist consumers who are already on the Clients page and seeking a Special Enrollment Period (SEP), edit the application from the client's Details page.

The term exchange refers to the Marketplace, either the Federally Facilitated Marketplace (FFM) or a State-based Exchange (SBM). The Marketplace determines the tax household’s eligibility for coverage and financial assistance.

Off-exchange plans do not go through the Marketplace, so they are not subsidy eligible. An enrollment submission takes place once the plan selection is finalized and the off-exchange application is completed.

On-exchange plans are subsidy eligible. An enrollment submission takes place once the plan selection is finalized and the subsidy application is submitted.

Affordable Care Act (ACA) compliant plans must cover the same essential health benefits, whether the plan is purchased on-exchange or off-exchange. Plan availability and pricing can vary when shopping on-exchange vs off-exchange, depending on the state and carriers.

Medicaid eligible or Children’s Health Insurance Program (CHIP) on the quoter does not mean the consumer is automatically enrolled in Medicaid or CHIP. Based on the information provided, the quoter estimates that the consumer could be eligible for Medicaid or CHIP. Final eligibility for coverage & financial assistance is determined by the Marketplace after the consumer completes the subsidy application.

Consumers can also apply for Medicaid or CHIP directly through their state Medicaid agency.

Affordable Care Act (ACA) plans fall into four different categories referred to as metal levels. Metal levels include Bronze, Silver, Gold, and Platinum plans. The main difference between each metal level is how costs for covered services are shared between the carrier and the consumer.

Catastrophic plans are also available to certain consumers.

Catastrophic plans cover the same 10 essential health benefits as the other metal levels and typically have low monthly premiums coupled with high deductibles. Advance premium tax credit (APTC) and cost-sharing reductions (CSR) cannot be used toward Catastrophic plans.

No. Catastrophic plans are only available to consumers under 30 years old and to consumers who qualify for an exemption.

If a consumer is over 30 years old and wants to purchase a Catastrophic plan, the consumer must qualify for an exemption. Consumers who are under 30 years old do not need an exemption to purchase a Catastrophic plan.

There are two types of exemptions available to consumers over 30 years old seeking Catastrophic coverage:

To apply for an exemption, consumers should complete an exemption application form. Hardship exemptions based on being ineligible for APTC or CSR due to projected annual household income may also be automatically calculated during the subsidy application process. Note: This applies to consumers applying through the Federally Facilitated Marketplace (FFM) as well as consumers applying through Georgia Access.

The federal poverty level (FPL) is a measure of income updated each year that is used to determine eligibility for certain programs and benefits such as ACA subsidies, Medicaid, and the Children’s Health Insurance Program (CHIP).

The 2025 FPL chart will be used to determine subsidy eligibility during plan year 2026 Open Enrollment Period.

A tax household is everyone included on one federal income tax return: the tax filer, their spouse if filing jointly, and anyone they claim as tax dependents.

Even if not everyone in the tax household is applying for Marketplace coverage, the Marketplace uses tax household information from the subsidy application to determine eligibility for coverage and financial assistance for those who are applying.

Consumers should include the estimated modified adjusted gross income (MAGI) their tax household expects to have for the coverage year. Marketplace savings are based on expected income for the year the consumer wants coverage, not last year’s income.

HealthSherpa includes resources in the application that explain what income to include, what income to exclude, and how to enter it.

No. The quoter does not calculate the affordability of employer-sponsored coverage. If a consumer is offered employer-sponsored coverage, they will need to complete the subsidy application for the Marketplace to determine final eligibility for coverage & financial assistance.

The application asks for information about the employee-only cost and the family cost of employer-sponsored coverage. These questions help the Marketplace determine affordablity and whether it meets the minimum value standard.

Prior to plan year 2024, there was a glitch in how affordability was calculated for family members, which was commonly known as the family glitch.

To see the coverage associated with a specific plan, click Plan details on the plan card, then select the Summary of benefits and coverages (PDF) link. The PDF is created by the carrier and outlines plan coverage details and coverage levels available to the consumer.

Dental coverage works different depending on whether it's purchased on-exchange or off-exchange.

Off-exchange dental plans:

On-exchange dental plans:

No. HealthSherpa supports enrollment submissions for all states that use the Federally Facilitated Marketplace (FFM). HealthSherpa also supports enrollments in Georgia, which uses a State-based Marketplace (SBM) called Georgia Access.

For all other states utilizing an SBM, agents can get a quote and shop for plans using HealthSherpa. When it's time to apply and complete an enrollment submission, HealthSherpa will direct the agent to the state's SBM website.

Plan display depends on the account type, whether the plan is on-exchange or off-exchange, and whether it is a medical or dental plan.

For on-exchange plans, HealthSherpa for Agents and Enrollee Assistance Full-Service accounts display all plans available in the consumer's ZIP code & county by default. Carrier-specific accounts display plans from a single carrier only. Review creating an account and carrier settings to learn more.

For off-exchange medical and dental plans, HealthSherpa supports select carriers and states. Review off-exchange medical plans and off-exchange dental plans for the current list of available carriers by state.

Yes. Use the browser search tool to find words or phrases on the page.

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

When using the print function while quoting, agents are given the option to download the quote, physically print the quote, or save the quote as PDF.

Default browser behavior when saving a quote as a PDF deactivates live links. Agents wanting to preserve live links when saving should leverage the download option.

For help using HealthSherpa or for other assistance, contact Agent Support. Agent Support is available by phone at (888) 684-1373, by email at Support@HealthSherpa.com, or by chat directly from your account.

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