Frequently Asked Questions

Yes, most carriers require brokers to be fully contracted and appointed before paying commissions. Some states and carriers may have exceptions, but it’s crucial to check each carrier’s policy.

Many carriers offer performance-based bonuses to brokers who meet enrollment targets. These bonuses can be per-member incentives, lump sum payments, or other rewards based on the number of policies sold.

Commission structures vary by carrier. Some pay per-member per month (PMPM), while others pay per contract per month (PCPM). Many carriers also offer renewal commissions based on retention.

In New York, individuals over 65 may qualify for the Essential Plan only if they do not qualify for Medicare. Brokers should verify eligibility based on income and residency status.

Brokers looking to get contracted should contact an FMO (Field Marketing Organization) or directly reach out to carrier broker support teams. Many FMOs provide free guidance and assistance with the process.

In most cases, brokers only need a Health license to sell Essential Plans. However, it’s best to check with state regulations and carriers for any additional licensing requirements.

On-Exchange plans are purchased through the ACA Marketplace, where individuals can qualify for subsidies. Off-Exchange plans are purchased directly from insurance carriers and do not qualify for federal subsidies.

Yes, clients can switch from an Off-Exchange plan to an On-Exchange plan, but they must do so during Open Enrollment or qualify for a Special Enrollment Period (SEP) due to a life event.

Special Enrollment Periods (SEPs) allow individuals to enroll in a Qualified Health Plan outside of Open Enrollment due to qualifying life events such as losing health coverage, moving, getting married, or having a baby. New York also offers unique SEPs based on income and other eligibility criteria.

Yes, brokers must obtain consent from clients before assisting them with plan selection, application submission, or making changes on their behalf. This is required for compliance with carrier and regulatory policies.

A Broker of Record (BOR) form is used to assign or change a broker on a client's policy. This allows brokers to receive commissions and provide ongoing support to the client. Some carriers require a BOR form for transfers outside Open Enrollment.

Transferring a client typically requires completing a reassignment form with the carrier or waiting for an Open Enrollment Period when the client can actively select you as their broker. Some carriers allow client transfers under certain conditions.

Medicare has several enrollment periods, including the Initial Enrollment Period (IEP), Annual Enrollment Period (AEP), Special Enrollment Periods (SEP), and Open Enrollment Period (OEP) for Medicare Advantage plans. Brokers should guide clients based on their eligibility and circumstances.

Most carriers require brokers to renew their certifications annually. This ensures that brokers stay updated with the latest plan offerings, compliance regulations, and market changes.

To sell ACA plans, brokers typically need to complete FFM certification (for federally facilitated marketplaces) or state-specific training. For Medicare, brokers must complete AHIP or NAHU certification, as well as carrier-specific training.

Yes, most carriers require brokers to complete individual training and pass an exam before they are allowed to sell their plans. Some carriers also require brokers to contract through an FMO.

If you miss the deadline to certify with a carrier, you may not be able to sell their plans for the upcoming plan year. Some carriers offer a grace period, but it’s best to complete certifications early to avoid losing sales opportunities.

Most carriers provide online portals where brokers can complete certifications. These portals include training modules, exams, and compliance documents. FMOs often provide direct access links to make the process easier.

Some carriers provide free certification training, while others charge a fee. The AHIP Medicare certification, for example, has a cost, but FMOs may offer discounts.

Carrier Certifications are required by insurance providers before a broker can sell their plans. They ensure brokers are knowledgeable about the carrier’s policies, benefits, and compliance rules. Most carriers require annual certification for ACA and Medicare plans.

Medicaid eligibility is based on income level, which varies by state. Generally, individuals and families with incomes below a certain percentage of the Federal Poverty Level (FPL) qualify. Brokers should check state-specific guidelines for accurate information.

No, individuals eligible for Medicaid are not eligible for ACA subsidies. If a client qualifies for Medicaid, they must enroll in their state Medicaid program instead of purchasing an ACA Marketplace plan.

If a client's income increases or decreases significantly, they may lose or gain Medicaid eligibility. Those who become ineligible for Medicaid may qualify for an ACA plan with subsidies, while those whose income decreases may be transferred from an ACA plan to Medicaid.

No, individuals enrolled in Medicaid cannot simultaneously have an ACA plan. If they qualify for Medicaid, they must use that coverage instead of a Marketplace plan.

The Essential Plan is available for low-income individuals in New York who do not qualify for Medicaid but still need affordable coverage. It provides low-cost premiums and covers essential health benefits.

Yes, if a client's income increases above the Medicaid eligibility threshold, they may qualify for an ACA plan. They should report income changes immediately to avoid gaps in coverage.

Consumers who qualify for Medicaid based on income may be directed to their state's Medicaid program instead of purchasing a plan through the ACA Marketplace. Brokers should be aware of income limits and help clients determine eligibility.

Brokers can get contracted with carriers by completing the carrier’s appointment process. This typically involves filling out an application, submitting licensing documents, completing background checks, and meeting any additional carrier-specific requirements. Most ACA and Medicare carriers require brokers to complete training and certifications before selling their plans.

Most major carriers, including UnitedHealthcare, Aetna, Cigna, Humana, and Blue Cross Blue Shield, offer commissions to brokers selling ACA and Medicare plans. Commission rates vary based on the carrier, plan type, and state regulations. Brokers should check directly with carriers or FMOs to get detailed commission structures.

Yes, blackout periods occur when brokers cannot submit applications or make changes to plans due to regulatory restrictions. For example, after the ACA Open Enrollment Period ends, applications for ACA plans can only be submitted during a Special Enrollment Period (SEP) with a qualifying event. Additionally, Medicare brokers should be aware of CMS blackout dates during the Annual Enrollment Period (AEP), where marketing certain plans is restricted until compliance approvals are given.