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The Beginner's Guide to Selling Marketplace Health Insurance Plans

Insurance Agent Development
Apr 19, 2022
7
minute read
Nectar Team
The Beginner's Guide to Selling Marketplace Health Insurance Plans

The Health Insurance Marketplace, also known as the Marketplace or exchange, is a federal government operation that makes health insurance available to all. Through the Health Insurance Marketplace, individuals can go shopping, find, and enroll in a health insurance plan that works for them.

For insurance agents, the Health Insurance Marketplace presents a unique opportunity to connect with individuals shopping for health insurance, as well as small businesses providing health insurance to their employees. It's an important sales outlet if you plan on selling health insurance coverage.

In this guide, we'll explore how the Marketplace works and how you can get started selling plans through it.

What Is the Health Insurance Marketplace?

The Health Insurance Marketplace was born from the Affordable Care Act (ACA) in 2010. By the fall of 2013, exchanges were available for individuals, with family health coverage following in 2014. Most states rely on the federal government’s HealthCare.gov site, while other states like Pennsylvania and New Jersey run their own marketplaces.  

Individuals seeking health insurance provide information about their household and income. Through the Marketplace, they will then get information on health insurance qualifications. They may qualify for premium tax credits, as well as other savings. It is also possible they will get coverage through the Medicaid and Children’s Health Insurance Program (CHIP), depending on their state's requirements.  

The Marketplace is designed to make health plan shopping simpler with a centralized hub of call centers, website information, and in-person assistance as needed. The goal for the Marketplace is to be a resource for anyone seeking health insurance outside their employer.

The Small Business Angle

Small business owners looking for health insurance for their employees can also benefit from the exchange, via the Small Business Health Options Program (SHOP). This works similarly to the individual Marketplace, but businesses can shop for health insurance for all their employees' needs rather than only individual or family plans.

With the SHOP program, small businesses can seek out private insurance at a price point they can afford. Like individuals, businesses may qualify for tax credits, too. Before the Affordable Care Act, many small businesses simply could not afford to offer private health insurance to their employees. Now that SHOP is in place, it is far more feasible for many companies.

How Does the Marketplace Work?

The Marketplace offers a combination of government and private health insurance offerings, but there are standards plans must meet for insurers to be eligible to participate. For an insurer to offer a policy, it must offer 10 essential health benefits:

  1. Laboratory services
  2. Emergency services
  3. Prescription drugs
  4. Maternity and newborn care
  5. Services for mental health and substance abuse
  6. Hospitalization
  7. Pediatric services, inclusive of oral and vision
  8. Ambulance services
  9. Preventative and wellness services, inclusive of chronic care
  10. Rehabilitative services

Plans must also offer a minimum value of 60%, meaning the insurance company pays 60% of allowable charges, while the insured is responsible for the other 40%. This is known as the Bronze plan category. The metallic category levels of insurance plans under the Health Insurance Marketplace include the following:

  • Bronze Plan: Split of 60% payment by insurance company, 40% by insured
  • Silver Plan: Split of 70% payment by insurance company, 30% by insured
  • Gold Plan: Split of 80% payment by insurance Company, 20% by insured
  • Platinum Plan: Split of 90% payment by insurance company, 10% by insured

The federal government enforces these standards so everyone can have adequate coverage. Another noteworthy standard is that plans cannot exclude folks with pre-existing conditions.  

Insurance agents or brokers must understand these requirements before starting to sell on the Marketplace.  Insurers offering Platinum levels will carry higher premiums and cover more claims, while Bronze plans will do the opposite.

Should I Sell Insurance on the Marketplace?

Any health insurance agent should strongly consider selling insurance on the Marketplace. It's a smart move for a variety of reasons, including:

  • Commission: The commission you get from an insurance company for selling a policy through the Marketplace is the same you would have gotten on a similar policy not sold through the Marketplace.  
  • Networking: The goal for any instance agent is to build up a network of clients they can rely on over time. The system with the individual Marketplace as well as the SHOP Marketplace for small businesses allows you to create a broker profile, increase visibility, and build up your client base.
  • Ease of use: You can use the HealthCare.gov site or the state equivalent to help clients fill out applications, complete enrollments, set up renewals, make changes, and more.
  • Help clients: You want to help clients find the right policy at a price they can afford. An exchange that helps them get subsidies and tax credits sweetens the deal.  

In 2021, there were 11.3 million Americans with active enrollment in a Marketplace plan. That shows there's plenty of potential for growth as an insurance agent through the Health Insurance Marketplace.

How To Sell Health Insurance on the Marketplace

Before you join the Marketplace, do your homework. Research the Affordable Care Act and what policies must include to comply with its requirements. Once you're ready to sell health insurance on the Marketplace, you need to get set up on the Centers for Medicare and Medicaid Services (CMS) portal. Once you are up and running on the portal, you can get started as an active agent.

Step 1: Create your CMS Enterprise Portal account

To complete the first step, you must create an account on the CMS Enterprise Portal. Once you complete the account, you can proceed through the enrollment steps. Be sure to check to see if you have an existing account before creating something new. If so, you'll simply need to renew your account.

Step 2: Become an agent or broker

Now that you have an account, you can follow the prompts on the screen to become an agent or broker. Log in to the CMS Enterprise Portal and select “Request Access Now.” Once you click that, choose the option that states “FFM/Training — Agents/Brokers/Assisters” and then “FFM Agent Broker.” This will bring you to the official agent or broker registration screen.

Step 3: Verify your identification

You need to confirm you are who you say you are. Answer some basic questions that will verify your identity, then the system will then return you to the home page, where you will have an assignment as an agent or broker.

Step 4: Focus on the necessary training

You need to complete training in order to be an active agent or broker on the Health Insurance Marketplace. On the CMS Enterprise Portal, you will find the necessary training by clicking on “Complete Agent Broker Training.” When you access the training, you will find all the resources you need within the Marketplace Learning Management System (MLMS).

There are a few different options when it comes to training. If you plan to just sell to individuals, choose the “Individual Market” curriculum option. If you plan to sell to small businesses, you want to choose that option. You also have the ability to do both tracks so you can sell to both sets of clients.

If you need continuing education units (CEUs) you have the option to do training through a vendor CMS approves.

Step 5: Sign security agreements and activate

The last piece of the puzzle is to sign the CMS privacy and security agreements. This is all done electronically and through the curriculum screen. Once you have your certificate that states your registration is complete, save a copy to your desktop or print out a physical copy.

State exchanges will follow a similar process, but each process and interface will be state-specific. For example, Pennsylvania has separate resources, training, and requirements for insurers to sell on their platform.  

The Bottom Line

In the ACA era, the Health Insurance Marketplace provides an essential sales outlet for insurance agents. With the Marketplace, you can create a broker profile, execute training, and be in a position to connect with millions of clients. During the open enrollment period (traditionally from Nov. 1 through Jan. 15), you can work with clients to help them get the right policy for themselves and their families, or with small businesses on behalf of their employees.  

The Health Insurance Marketplace is a great supplemental income for insurance agents. You can use it in combination with lead generation software from Nectar to bring in real-time health insurance leads and live transfer health insurance leads outside the exchange. As you build out your overall insurance book of business, utilize the Marketplace, Nectar leads, and your insurance knowledge base to build a brand for yourself and flourish as an agent.

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This article reflects the features of Nectar as of the date of publication. Features are subject to change at any time. This article is meant for informational purposes only, it is not a guarantee that using Nectar will help you achieve specific business or financial results and is not intended to serve as the sole recommendation for any business financial decisions.

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