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After the subsidy application is submitted to the Marketplace, agents can split applicants into separate plans when needed by shopping multiple plans.
In this article we’ll cover:
When to shop multiple plans
Shopping multiple plans is useful when applicants in the same tax household have different medical needs, eligibility differs across applicants, or when applicants require separate policies.
Agents may choose to shop multiple plans when, for example:
Different provider networks are needed.
Prescription drug formulary needs are different.
A household member qualifies for additional American Indian or Alaska Native (AI/AN) benefits but others do not.
Cost-sharing reductions (CSR) eligibility differs across applicants.
Applicants want separate deductibles and out-of-pocket maximums.
Policies must remain separate due to a court order.
Shop multiple plans functionality
Shop multiple plans functionality is available only after the subsidy application is submitted to the Marketplace, and a Marketplace Eligibility Notice is generated with the consumer’s final eligibility results.
If a plan was not selected previously, select Shop multiple plans from the Review eligibility results page.
If a plan was selected previously, select Shop multiple plans from the Confirm your plan page.
It is not possible to shop multiple plans using the quoter or before eligibility results generate.
After selecting Shop multiple plans, the HealthSherpa account loads the Choose multiple plans page.
Choosing multiple plans
Select the checkbox next to each consumer you want to shop for, then select Choose a plan.
Then plan results page will launch allowing you to review available plans with the consumer and narrow options based on the consumer’s needs. Add a plan to the cart to return to the Choose multiple plans page and repeat the shopping process for remaining applicants.
Grouping applicants
By default, applicants who select the same plan are grouped together. When applicants are grouped, they share the same premium payment, family deductible, and family out-of-pocket maximum.
If applicants should not be grouped even though they chose the same plan, the agent can opt out of grouping on the Group Shopping page by unchecking the grouping option.
After plans are selected and grouping decisions are finalized, select Continue to proceed to the Confirm your plan page and submit the enrollment.
Frequently asked questions
Do applicants on separate plans pay premiums together or separately?
Applicants who are enrolled in separate groups have separate premium payments. Each group has its own deductible and out-of-pocket maximum. Applicants who are grouped together on the same plan share one premium payment, a family deductible, and a family out-of-pocket maximum.
How is advance premium tax credit (APTC) calculated for multiple enrollment groups?
The advance premium tax credit (APTC) for the household is allocated across applicants using a Centers for Medicare & Medicaid Services (CMS) formula. If an applicant does not use all of their allocated APTC, the remaining amount is applied to the next applicant in the list.
When shopping, the plan results page shows the APTC amount for the applicants currently selected. Any remaining APTC is visible on the Confirm your plan page.
How do multiple enrollment groups appear in the HealthSherpa account?
On the Clients page, the plan selected for the primary applicant displays. Select the consumer’s name from the Clients page to open their consumer record and view additional plan information.
How does the Enrollee Assistance Program (EAP) function when working with multiple enrollment groups?
CMS allows only one Agent of Record (AOR) per Marketplace application. Carrier settings associated with the primary applicant’s plan apply to all plans selected.
Are all tax households able to shop multiple plans?
Not always. Applicants who live in different ZIP codes cannot be grouped together and may not be able to shop the same plans. In addition, CMS does not allow Catastrophic coverage on applications that use multiple enrollment groups.
Is it always possible to group applicants who are on the same plan?
No. Some plans have rules that prevent certain applicants from being in the same group. For example, some plans require applicants to reside together to be grouped. When this happens, the HealthSherpa account automatically splits applicants into different groups and shows the groupings on the Confirm your plan page.
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: group, groups, enrollment, split, policies, policy