Everything Agents Need to Know About Selling in State-Based Marketplaces

Agents who actively sell Affordable Care Act (ACA) 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 post 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 19 states and D.C. that use SBMs and three states (AR, IL and OR) that use SBM-FPs. Georgia is now a state-based marketplace. 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:

• Maryland: Agents must apply and complete initial training to receive their authorization to sell. Broker authorization expires after two years. The exchange will send a renewal notice no later than 60 days prior to expiration date. Annual certification is also required.
• New Jersey: Agents must first complete the Broker Intent to Sell form. Annual certification is also required.
• New York: Agents are not required to certify annually, but must certify every two years from their initial certification date.

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:

• Connect for Health Colorado
• Georgia Access
• Kentucky Health Benefit Exchange
• Maryland Health Connection
• GetCoveredNJ
• NY State of Health
• Pennie
• Virginia’s Insurance Marketplace

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 that some states can set their own OEP dates.

States that begin open enrollment on a different date:

• Indiana — October 15

States that may end open enrollment on a different date:

• California — January 31
• D.C. — January 31
• Idaho — December 16
• Massachusetts — January 23
• New Jersey — January 31
• New York — January 31
• Rhode Island — January 31

Generally speaking, clients who enroll before December 15, will have a January 1 effective date. A client who submits their application on or after December 16 through the end of the OEP will have an effective date of February 1. This may differ in some states. For example, 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 some states 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.

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.

If you’re not already a Ritter agent, register today to utilize all of our resources such as guides and eBooks, exclusive webinars and trainings, and our experienced Sales team.