By Mikh Yusupov, M.P.A. | Founder & President, Affordable Care Agents
Published: April 15, 2025
For the second year in a row, the ACA Marketplace has hit record-breaking enrollment numbers — with over 21.4 million Americans enrolling in health coverage through federal and state exchanges during the latest Open Enrollment Period (OEP).
In New York State, the trend is even more powerful — driven by extended premium tax credits, Medicaid redeterminations, and a growing reliance on certified brokers. The message is clear:
If you're not actively building your ACA book in 2025, you're missing the biggest opportunity in health insurance today.
Why This Record-Breaking Surge Matters for Brokers
1. 21.4 Million Strong — and Still Growing
ACA enrollment has reached its highest level ever. In New York, over 70% of Marketplace enrollments were completed with the help of licensed brokers — further cementing our role as trusted advisors.
2. Medicaid Unwinding = Millions of Eligible Consumers
The end of continuous coverage protections is pushing thousands of New Yorkers off Medicaid and into Essential Plan or Qualified Health Plans (QHPs). These consumers require urgent guidance to avoid gaps in coverage — and brokers are perfectly positioned to help.
3. Enhanced Commissions and Year-Round SEP Activity
Special Enrollment Periods (SEPs) tied to life events and Medicaid terminations have made ACA a 12-month opportunity. With strong compensation and high retention potential, brokers have year-round business-building potential.
5 Ways to Grow Your ACA Book in 2025
1. Target Medicaid Disenrollees
With an estimated 90,000+ disenrollments monthly in NY, brokers can help transition eligible individuals into the Essential Plan or a QHP — and retain them long-term by supporting plan selection, SEP triggers, and renewal readiness.
2. Master the Essential Plan
The Essential Plan (EP) is a key offering for low-income consumers. Brokers who understand FPL-based eligibility tiers, documentation shortcuts like Self Declaration of Income, and tools like the DOH-5088 identity form can enroll efficiently and compliantly.
3. Leverage Special Enrollment Periods (SEPs)
Marriage, divorce, income changes, immigration status updates, and other qualifying events are driving constant SEP opportunities. Building SEP outreach strategies is essential for year-round ACA success.
4. Understand Immigration-Based Eligibility
Immigration eligibility is one of the most nuanced — and underserved — areas of ACA enrollment. Brokers should be familiar with:
- PRUCOL classifications
- I-862 Notices to Appear
- Pending asylum or parole status
- DACA recipients
- Special Immigrant Visa (SIV) holders
Understanding NYSOH immigration categories and document types is crucial for serving mixed-status households, recent migrants, and asylum seekers. This is a growth area brokers can't afford to overlook.
5. Provide End-to-End Service (Medicaid to Medicare)
Clients who experience income shifts, childbirth, or turn 65 often need help transitioning to a new program. Brokers who manage cross-program movement — like QHP to Medicare Advantage — are positioned to earn long-term loyalty and renewals.
Keeping Up with Federal and State-Level Enhancements
The Inflation Reduction Act has extended APTC enhancements, reduced out-of-pocket costs for seniors, and added new drug pricing provisions. Meanwhile, New York State continues to update its EP eligibility rules, SEP definitions, and identity proofing requirements.
Brokers must stay informed on:
- Updated FPL thresholds
- SEP eligibility expansions
- New Essential Plan rules
- NYSOH immigration training and system enhancements
Follow Affordable Care Agents for Broker Trainings
Affordable Care Agents provides ongoing broker education, updates on federal and NY-specific ACA changes, and access to compliance-ready tools like FPL charts, identity verification forms, and desk aids.
Brokers are encouraged to follow our upcoming trainings on:
- Special Enrollment Period strategies
- Immigration eligibility and PRUCOL guidance
- Essential Plan tier navigation
- Document handling and attestation workflows
The ACA Marketplace is more dynamic than ever — and the brokers who specialize, adapt, and stay informed are positioned to lead in 2025 and beyond.
