Latest From CMS on Exchanges: "Agents and Brokers Will Play a Role"

  • Originally published May 8, 2013 , last updated February 10, 2015
  • ACA

For years now we’ve known the insurance exchanges are coming. What hasn’t been clear is whether the exchanges represent an opportunity for agents to expand into a new market, or an opportunity for the carriers to market their products directly to consumers and cut agents out of the mix.

On May 1, 2013, CMS addressed this issue in a document titled "Health Insurance Marketplace Guidance: Role of Agents, Brokers, and Web-brokers in Health Insurance Marketplaces."

The first paragraph of this 12-page document should be encouraging for agents and brokers.

“Agents and brokers, including web-brokers, are among those who will play a role in educating consumers about Marketplaces and insurance affordability programs, and in helping consumers receive eligibility determinations, compare plans, and enroll in coverage. In particular, CMS anticipates that agents and brokers will play a critical role in helping qualified employers and employees enroll in coverage through the Small Business Health Options Programs (SHOPs).”

The document goes on to detail how agents and brokers can participate. Here are some of the highlights:

  • Agents and brokers will be able to assist consumers in two ways: (a) an issuer-based pathway, through which an agent or broker uses an issuer’s website to assist the consumer; or (b) a Marketplace pathway, through which an agent or broker assists the consumer using the Marketplace website. Both pathways will transmit an agent’s or broker’s identifying information to the appropriate issuer to facilitate the issuer’s payment to the agent or broker for each enrollment transaction.
  • Agents and brokers must register with CMS in order assist qualified individuals for individual Marketplace coverage. Online registration process will begin in the summer of 2013. Registration will include a Marketplace-specific online training course.
  • Once an agent is registered, he or she will receive a MarketPlace ID. This is the unique identifier that will allow the agent to get paid.
  • As is the case today, agents and brokers will be appointed by issuers; issuers will check the agent’s or broker’s licensure status and will verify an agent or broker’s registration with the Federally-facilitated or State Partnership Marketplace. Agents and brokers will provide copies of their Federally-facilitated Marketplace training certificates and user IDs to issuers as part of the appointment process.

Open enrollment starts October 2013, same time as the AEP for Medicare Advantage. It’s going to be an interesting fall.