Agents who actively sell Affordable Care Act insurance plans typically do business through either the federal exchange or state-based marketplaces. You’re likely familiar with HealthCare.gov, the federal exchange, but what are state-based marketplaces and how do they work?
Let’s review the information you need to know to effectively reach this demographic of your business and expand your sales!
Note: Throughout this article we may use “exchange” and “marketplace” interchangeably when referring to the platforms used to purchase ACA health plans.
State-Based Marketplaces Explained
A state-based marketplace (SBM) is a health insurance exchange that’s independently orchestrated by a state’s government. These exchanges offer plans that are supported in a specific state and available for purchase.
States that haven’t established their own exchange will participate in the Federally Facilitated Marketplace (FFM), aka the federal exchange. Clients who enroll in a marketplace plan in states that do not have an SBM enroll in coverage through HealthCare.gov or an approved Enhanced Direct Enrollment (EDE) site.
State-Based Marketplace-Federal Platforms
There’s an additional category of SBM that deserves to be recognized — State-Based Marketplace-Federal Platforms (SBM-FP). In this type of marketplace, the state is responsible for conducting all usual business for an individual marketplace but relies on the federal exchange for eligibility and enrollment functions. Clients in SBM-FP states enroll in coverage through HealthCare.gov.
The states participating in SBM and SBM-FP exchanges are noted on the map below.
Which States Utilize SBMs?
Currently, there are 18 states that use SBMs and three states (AR, OR, and VA) that use SBM-FPs. Two states (GA and VA) are planning to transition to an SBM for fall 2023. Use the map below to see if your state participates in an SBM, and if Ritter supports products in your state!
Agent Training Requirements
Agents who are looking to sell under-65 plans in SBMs should be aware that there are training requirements for each exchange. These training requirements vary by state; we recommend checking with each exchange you’d like to sell through and completing training through their platform.
Ritter works with the following states that have special training requirements:
- New Jersey: Agents must first complete the Broker Intent to Sell form.
- Georgia: Starting fall 2023, agents must complete state training when available.
- Virginia: Starting fall 2023, agents who previously sold while VA was associated with the FFM have the option to complete recertification through HealthCare.gov, HealthSherpa, or Virginia’s SBM when training is available.
These training requirements vary by state; we recommend checking with each exchange you’d like to sell through and completing training through their platform.
Note: Agents who sell ACA products in FFM states must complete FFM training through HealthCare.gov or HealthSherpa.
State-Based Marketplace Enrollments
Agents enrolling clients residing in SBM states should complete enrollments through the state’s platform. Find the right exchange here
Here are the links to the SBMs Ritter currently works with:
The process of enrolling a client in one SBM may vary from enrolling them in another SBM or the federal exchange. We recommend taking your time and following the instructions on the state’s platform.
Coverage Effective Dates
The Open Enrollment Period (OEP) runs from November 1 to January 15 in most states. Be aware, states that operate an SBM can set their own OEP dates. Generally speaking, clients who enroll before December 15, will have a January 1 effective date. A client who submits their application after December 15 until the end of the OEP will have an effective date of February 1. Maryland and New Jersey are exceptions.
- Maryland: Coverage starts January 1 for applications submitted by December 31. Coverage starts on February 1 for applications submitted the first two weeks of January.
- New Jersey: Coverage starts January 1 for applications submitted by December 31. Coverage starts on February 1 for applications submitted between January 1 and January 31.
Be aware that states that operate an SBM can set their own OEP dates.
Any client who misses the OEP is only able to enroll in coverage by being eligible for a Special Enrollment Period (SEP). In these cases, coverage is effective the first of the month after the application is submitted.
Remember, coverage will not be effectuated until the binder payment is made. This payment is typically the first month’s premium and is due 30 days after enrollment.
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Selling ACA plans is a great opportunity to reach new customers and expand your business. The different exchanges don’t have to be as scary as they may seem. At Ritter, we’re committed to helping you understand SBMs, SBM-FPs, the federal exchange, and all changes and transitions that happen in the under-65 market.