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Applying refers to updating or beginning a consumer’s subsidy application so the Marketplace can determine the household’s eligibility for coverage and financial assistance. Agents can complete a subsidy application by searching the Marketplace or by selecting Enroll now after getting a quote.
In this article we’ll cover:
Searching the Marketplace
The Start application & Search Marketplace features allow an agent to search the Marketplace for existing applications and bring them into the HealthSherpa dashboard to service. Agents can also use these features to start a new application for consumers who may need to do so.
Start application & Search Marketplace
Start application & Search Marketplace
Selecting Start application or Search Marketplace opens the Marketplace search page. While the pages may appear different, the search criteria & Marketplace search functionality are the same.
With consent, enter the consumer’s information, then select Search the Marketplace.
If no results are found, verify the consumer’s information then search again or Create a new application if needed.
If the consumer has any existing Marketplace applications that match the information provided, search results populate.
Search results are sorted by plan year (most recent first), then application version (most recent first). When multiple results appear, consider using the hierarchy shown on the Marketplace search page, prioritizing statuses at the top of the list.
Claim an existing application when one exists, or create a new application when needed.
Claiming an existing application
Claiming an existing Marketplace application to the HealthSherpa dashboard allows the application to be managed by the agent, and generates an Enhanced Direct Enrollment (EDE) sync between the agent and the application.
To claim an existing application when one exists, select Apply or View in dash after searching the Marketplace.
Apply
Apply
Apply will appear when a consumer's application is not already associated with the HealthSherpa account. Select Apply next to the application to make updates to an existing application.
View in dash
View in dash
View in dash will appear when a consumer's application is already associated with the HealthSherpa account. Select View in dash next to the application to return to the client's Details 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.
Claiming an application does not impact the National Producer Number (NPN) associated with the application.
Creating a new application
Creating a new application may be needed when no Marketplace search results are found or when a consumer needs a new Marketplace application (for example, if the consumer moved to a new state).
Select Create a new application to continue.
Agents can only start a new application after completing a Marketplace search for existing applications. Before creating a new application, HealthSherpa recommends using the Search by Social Security Number (SSN) function to confirm the consumer does not have any existing Marketplace applications.
Completing an application
The Marketplace application asks for information about the consumer’s household to determine eligibility for coverage and financial assistance. Consumers do not have to be subsidy eligible to purchase Marketplace coverage, and they are not required to use financial assistance they may be eligible to receive.
Go to the agent training page for a live walkthrough of the subsidy application.
Applying for a subsidy within the enrollment submission flow
Applying for a subsidy and plan shopping are distinct parts of the flow that culminate in an enrollment submission. Enrollment submission can begin with completing the subsidy application or with plan shopping.
Once the subsidy application is submitted to the Marketplace, a Marketplace Eligibility Notice is generated with the consumer’s final eligibility results.
If the consumer is within an enrollment period, proceed to plan results to review available plans and find a plan that fits the consumer’s needs.
Frequently asked questions
What is a subsidy?
A subsidy is federal financial assistance designed to lower the cost of health insurance purchased through the Marketplace. Subsidy eligibility can consist of both advance premium tax credit (APTC) and cost-sharing reduction (CSR).
APTC: Refers to a dollar amount that may be applied on a consumer’s behalf to their monthly health insurance premium. APTC can be applied to all metal levels and may appear as Estimated savings in HealthSherpa.
CSR: A discount applied to silver level plans that lowers deductibles and out-of-pocket costs for care and prescription drugs. Consumers who are eligible for APTC may also be eligible for CSR. Consumers who are not eligible for APTC are not eligible for CSR.
What is an Enhanced Direct Enrollment (EDE) sync?
Centers for Medicare & Medicaid Services (CMS) grants EDE permission to agents for their enrollments, which enables data syncs. When an application has an EDE data sync, the HealthSherpa dashboard shows the most up-to-date application information.
With consumer consent, an agent can begin the enrollment process or search & claim the consumer's existing application to generate an EDE connection.
What is a Marketplace Eligibility Notice?
A Marketplace Eligibility Notice is an official letter from the Marketplace that is generated after a consumer’s subsidy application is submitted.
This notice explains the household’s coverage eligibility and financial assistance, known as subsidies, along with any follow-up actions needed to resolve Data Matching Issues (DMIs) & Special Enrollment Period (SEP) Verification Issues (SVIs).
What are enrollment periods?
Enrollment periods are specified times of the year when consumers can enroll in or make changes to Affordable Care Act (ACA) coverage.
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.
Keywords: Search & Claim