Selling health insurance to individuals under 65 isn’t as heavily regulated as Medicare sales, but Affordable Care Act (ACA) agents still need to follow certain guidelines.
In this section, we’ll go over the key qualifications you’ll need to meet to be ready-to-sell both during and outside the Open Enrollment Period (OEP). We’ll also share useful tools and resources to help simplify the enrollment process for your clients.
Get Ready-to-Sell: ACA Agent Requirements
To sell Marketplace (ACA) health insurance plans, agents must first be licensed, certified, and appointed with approved insurance carriers. Here’s what that process looks like:
Licensing Requirements
Agents must hold an active health insurance license in their resident state with the proper line of authority (LOA).
If you plan to sell in additional states, you’ll need to obtain a non-resident license for each one.
Once your licenses are active, you can move on to completing the required ACA certification to officially become ready-to-sell.
Certification Requirements
Every ACA agent must be certified before selling Marketplace plans.
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For the Federal Marketplace:
Agents must complete the Federally Facilitated Marketplace (FFM) Certification, available free of charge through the Centers for Medicare & Medicaid Services (CMS) or through Enhanced Direct Enrollment (EDE) platforms like HealthSherpa.-
First-time agents must take the full FFM training.
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Returning agents (those who sold ACA plans in the previous year) may take a shorter renewal version of the training.
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Once completed, the FFM certification allows agents to sell in all FFM states.
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For State-Based Marketplaces (SBMs):
If you plan to sell in an SBM state, you must complete that state’s specific training or certification program.
You can find your state’s Marketplace information [here].
Appointment Requirements
Before selling any plan, you must be appointed with each carrier whose products you intend to sell.
A carrier appointment is a formal agreement authorizing you to represent that insurer and its products. It also establishes your responsibility for accurately presenting and selling their plans in accordance with compliance guidelines.
Obtain Consumer Authorization
Before assisting clients with their ACA plan selection or enrollment, agents must first document the client’s authorization to provide help. This consent ensures compliance with Marketplace regulations and protects both the client and the agent.
Marketplace Requirements
According to CMS, every agent must record the following details when obtaining consumer consent:
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Date the authorization was given
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Name of the consumer (or their authorized representative)
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Name of the agent, broker, or agency receiving consent
Agents must retain this documentation for at least 10 years and be able to present it upon request from the Marketplace.
Acceptable Methods for Collecting Consent
Consumer authorization can be collected through:
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A signed written form
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Email confirmation
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A recorded phone call
All of these methods meet CMS compliance standards.
Helpful Resources
CMS provides a combined document that includes both consumer consent forms and call scripts to simplify compliant authorization collection. However, keep in mind that some states have additional requirements or their own approved forms (for example, Georgia). Always verify your state’s specific rules with its Department of Insurance (DOI).
Revoking Consent
Clients have the right to withdraw their authorization at any time. This rule helps prevent misunderstandings or disputes by ensuring agents only act on behalf of clients who have explicitly granted—and maintained—consent.
Obtain Consumer Eligibility Attestations
In addition to collecting consumer consent, agents must also document each client’s eligibility attestation—a confirmation that all information on their ACA application has been reviewed and is accurate.
CMS requires this attestation to be collected before the application is submitted and to include:
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Date the client reviewed the information
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Name of the client (or their authorized representative)
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Explanation of the attestations found at the end of the eligibility application
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Name of the agent or broker assisting with the enrollment
Documentation Requirements
Just like consumer consent forms, eligibility attestations must be kept on file for at least 10 years and be readily available in the event of a CMS audit.
Agents can gather attestations in any format the client prefers, including:
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Written documentation
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Email confirmation
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Recorded phone call
All three are recognized by CMS as valid forms of documentation.
Helpful Tools and State Guidelines
CMS provides standardized forms and call scripts to simplify this process. However, if your state has its own required forms or procedures, you must follow those instead. Always check with your state’s Department of Insurance (DOI) or Marketplace for specific requirements.
Why Eligibility Attestations Matter
Collecting and confirming eligibility attestations helps reduce errors and customer complaints related to inaccurate enrollment information. By verifying details up front, agents ensure a smoother, more reliable enrollment experience for their clients.
Recognize and Report Suspicious Activity
As an agent, you play a key role in protecting consumers’ personal information and ensuring ethical business practices. If you notice any signs of suspicious or fraudulent activity, it’s your duty to report it immediately.
Recently, there have been cases of unauthorized plan changes and marketplace account tampering. Some marketing call centers have been persuading consumers to switch plans with misleading offers of cash or savings.
Remember—your responsibility is to act in your clients’ best interest and safeguard their data at all times.
If you suspect unauthorized activity, contact the Marketplace Call Center right away at 1-800-318-2596 (TTY: 1-855-889-4325). Reporting these incidents not only protects your clients—it also helps protect your own business and ensures you receive the commissions you’ve earned.
At Essential Care, we know the insurance landscape is constantly evolving. That’s why we’re dedicated to keeping you informed of any updates that could affect your business. Our goal is to equip you with the tools, training, and compliance resources you need to stay successful, ethical, and fully aligned with the latest industry standards.
Not affiliated with or endorsed by Medicare or any government agency.
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