Agents and brokers who plan on assisting consumers in the Federally-facilitated Marketplaces have a number of roles and responsibilities to perform and requirements to meet. The success of the Federally-facilitated Marketplaces will depend on consumer satisfaction. Agents and brokers will play a critical role in the enrollment process, thus contributing to the overall success of the Marketplaces.
Agents and brokers can assist individuals, employers, and employees with enrollment in qualified health plans (QHPs) in the Federally-facilitated Marketplace. Agents and brokers may also assist qualified individuals with eligibility determinations for advance payments of the premium tax credit and cost-sharing reductions for eligible plans. Remember, the premium tax credit and cost-sharing reductions are only available to qualified individuals in the Individual Marketplace.
Agents and brokers assisting consumers in the Federally-facilitated Marketplace must do so in conformance with applicable state law, including conflict of interest and confidentiality provisions.
Web-brokers can also assist consumers in selecting and enrolling in a QHP through the web-brokers’ own websites. Web-brokers may also assist qualified consumers in the Individual Marketplace in applying for advance payments of the premium tax credit and cost-sharing reductions for eligible plans. Web-brokers must comply with additional regulatory requirements.
Agents and brokers in the Federally-facilitated Marketplaces are compensated in accordance with their agreements with QHP issuers and any state-specific requirements. The Federally-facilitated Marketplaces do not set compensation levels. Agents and brokers receive compensation from QHP issuers in the form of commissions as a result of assisting qualified individuals in enrolling in QHPs through the Marketplace.
A QHP issuer must pay the same broker compensation for QHPs offered through a Federally-facilitated Marketplace as they do for similar health plans offered in the state but outside the Federally-facilitated Marketplace. In fact, this compensation approach is a required condition of the QHP certification process for QHPs offered in the Federally-facilitated Marketplaces and Federally-facilitated SHOP.
Agents and brokers in both the Individual and SHOP Marketplaces will use their National Producer Number (NPN) to receive compensation from a QHP issuer.
If agents have questions on commissions, the first point of contact is the health insurance issuer..
See the Centers for Medicare & Medicaid Services' (CMS) Marketplace Guidance from May 1, 2013, on the Role of Agents, Brokers, and Web-brokers in Marketplaces: http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/agent-broker-5-1-2013.pdf
Agents and Brokers are required to be trained to assist consumers with the application and decision making process. Using an Agent to enroll in a ObamaCare Health Plan will be the primary choice of many americans. After all agents have the inside track on companies and their promptness to handle claims and pay benefits in atimely fashion.
Next Topic: Coverage Basics