October 24

ACA Training – How the Affordable Care Act Works, Products and Support from TMG


Here is an overview of ACA, the Affordable Care Act - Obamacare - individual health insurance for under age 65. There are so many different ways you can talk about this, but 3 of the most common questions we get about this are:

  1. 1
    Does Tidewater offer it?
  2. 2
    Does Tidewater support it?
  3. 3
    Can I just have some basic information on how all this works?

ACA Open Enrollment

November 1 through January 15

The answer is Yes, Yes, and YES! Open enrollment for ACA starts soon. It's from November 1 through January 15 when folks under age 65 that are not on Medicare can qualify for an ACA plan. We want to provide you with some generic information so you can make the best decision about whether or not you want to offer these plans.

First thing is, does Tidewater offer it? Yes, we do, 100%. We don't talk a lot about ACA, and the reason for that is because on the Medicare side, there's a lot more training involved. There are a lot of different things with ACA. It's guaranteed issue health insurance – there's no underwriting and there's no compliance around marketing. It's wide open.

We offer different carriers in different markets and states, such as Ambetter, Ascension, Molina, Bright Health, Anthem, Cigna, Oscar, Kristas, Medico, Caresource, AvMed, Friday Health, United Healthcare One, Aetna, SWHP, Highmark, and Blue Cross and Blue Shield.

There's no underwriting and there's no compliance around marketing.

Depending on the state you're in, we'll be able to let you know what's going on in these specific states, but just know that we do offer all of these different plans so that you can represent and partner with us on. If you want to see a list of this, please let us know. A lot of this has been updated, especially for Bright Health, because they are leaving all of the states that they were marketing in 2023.

ACA Enrollment Technology

Let's talk about enrollment technology. For many of you that are doing Medicare, you're very familiar with the MedicareCENTER. The MedicareCENTER is a powerful resource that helps you with pretty much everything on the Medicare side.

We use a CRM/enrollment platform called HealthSherpa.

Unfortunately, MedicareCENTER is only for the senior side. On the under 65 side, we use a CRM/enrollment platform called HealthSherpa, a customized website for you that you can market, you can drive people to, and where you can do the enrollments yourself. Basically, it's where your clients can sign up for the marketplace. You enter in the client's basic information and then based on their income, which they have to tell the truth about, it will let you know whether or not that client qualifies for a subsidy. When you think about subsidies for all my Medicare peeps out there, think of LIS; it helps bring down the cost and the premium based on their income.

They could base their income based on family if they're part of a family or an individual if they're an individual. ACA is like Medicare Advantage. There are no health questions. It's all underwriting.

What ACA plan should I put them on?

I got a phone call the other day from an agent. He asked me, "Mike, I got a guy who just got his leg amputated. What do I put him on for ACA? What carrier will take him?" Just write them in an ACA plan. It's guaranteed issue. You're really focusing on premium and what plans are available.

Market Disruption = Opportunity

There's also a massive opportunity across the country. Bright Health is exiting Medicare; they are pulling all of their plans, which means those members that were on Bright Health are going to have to go somewhere. When there's disruption, it creates an opportunity to help those other people enroll in a different plan.

When those residuals start piling up and you're getting that as earned money, you can really start deep diving into making a fantastic residual income.

ACA is all as earned. There are no advanced commissions. It's all as earned. It's paid based on the premium per that member per month. If you're writing life insurance or even if you're writing Medicare supplements and getting advanced on those commissions, just know with ACA it is all as earned. Medicare is also as earned and we call it mailbox money, residual income. ACA is structured the same way. It's going to pay you as earned.

In the first year, you're probably not going to make a ton of money. But in the second year, when those residuals start piling up and you're getting that as earned money, you can really start deep diving into making a fantastic residual income.

Those are the basics. If you are brand new to certifying for ACA, it's through the FFM certification. FFM certification is not like AHIP. It is not like the carrier certifications. It's much different. But there is a required certification for you to go through.

Give us a call at 888-622-9122 with any ACA inquiries!


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