5 Things to Know for ACA Open Enrollment Period

Written by Lexi Williams

November 4, 2020

ACA Open enrollment is officially here, and hopefully, you’ve had time to prepare for the busiest time of year. Whether you are selling ACA Health insurance for the first time, or you’ve had many years of experience, here are five things you should know for the 2021 ACA Open Enrollment.

Virtual Options

It’s essential to optimize your productivity during ACA OEP since you have a short time frame to reach your prospects and clients and sell subsidy-eligible metal tier plans. Additionally, many clients and prospects will be looking for alternatives to face-to-face meetings due to the current pandemic. Make sure you familiarize yourself with selling over the phone or other virtual meeting options such as Zoom, WebEx, or GoToMeeting. Click here to access one of our virtual training sessions on how to use Zoom in your sales presentations.


Silver plans offer many $0 deductible options. They are the most common choice of ACA shoppers during the open enrollment period because the additional cost-sharing credits can be applied to these metal tier plans. When applying the additional cost-sharing credits, silver plans’ coinsurance can resemble the coinsurance of a gold tier plan (80/20) without the additional out-of-pocket expenses or premium costs. A majority of the families will choose between ACA vs. STM based on their income and fall on the federal poverty level (FPL) – explaining the sales logic (e.g., value-based selling because of their situations with income can mean they may qualify for a $0 plan). So, it’s essential to review metal tier options and not merely enroll a client in a Short Term Medical plan because the premium appears to be more affordable on the surface level.

The COVID-19 pandemic has affected access to employment and healthcare coverage for as many as 12 million Americans since February 2020, according to a study from the Economic Policy Institute. Some will turn to Medicaid; however, the ACA marketplace will provide affordable options for many Americans.

Many clients don’t know that ACA metal tier plans must cover essential health benefits such as emergency services, preventive/wellness services, some pediatric, hospitalization, prescription drugs, therapy & rehabilitative, etc. It’s essential to take time to review these and other benefits found in guaranteed issue ACA metal tier plans. Because of the federal poverty level and your client’s income – they may find a short-term medical plan is a better option. Having the opportunity to screen share and walk-through copays, deductibles, and coinsurance of ACA metal tier plans and short-term medical plans creates value for your clients and helps them make an informed decision regarding their health coverage this OEP.

Remember, All ACA metal tier plans are required by law to cover these essential services:

  • Emergency services
  • Outpatient and ambulatory services
  • Preventive/wellness services
  • Maternity and newborn care
  • Pediatric services
  • Hospitalization
  • Therapy services
  • Prescription drugs
  • Laboratory services
  • Mental health
  • Substance abuse services

Network Additions

The Affordable Care Act, also known as ACA, requires that all eligible health plans offer adequate network coverage. Often carriers will strengthen their position in the market by expanding their network and adding hospitals, healthcare providers, and healthcare facilities. Check your client’s current plan and plans they may be considering, ensuring the network meets their needs.

New carriers in Your Market

Each year insurance carriers enter, exit, and expand in various markets. While some of your clients may be leery about new insurance companies, be on the look-out for new carriers—especially those metal tier plans “on the marketplace.”. Determine what plans are available in your client’s zip code. They could be saving on their monthly premium or gaining additional benefits.

Marketing Opportunities

Due to COVID-19, many of your clients may have experienced income changes due to reduced hours or employment loss. It’s a good idea to contact previous clients and lost leads since it’s likely their circumstances have changed. This allows you to improve your client experience and leverage your book of business.

ACA Supplemental Coverage Options

Although Supplemental insurance doesn’t meet the qualifications for minimum coverage and benefits for ACA, it may make sense for some clients to add supplemental health insurance to fill in the gaps of coverage. A supplemental health insurance plan is a health care plan that covers anything above and beyond minimum essential medical coverage. With a Supplemental plan, clients can extend their health coverage, offset out-of-pocket expenses, cover deductibles, and protect their income. It all depends on what type of supplemental plan your clients need.

Here are some Supplemental Plan Options:

  • Dental
  • Vision
  • Critical Illness
  • Long-Term and Short-Term Disability
  • Travel Insurance
  • Long-Term and Shot-Term Care
  • Cancer
  • Accidental death and dismemberment

Although the 2021 ACA Open Enrollment looks a little different this year, with Agent Pipeline, you can have the best OEP yet! We believe that insurance agents are most effective when armed with excellent tools and support. We provide back-office support, marketing tools & technology, compliance reviews and assistance, enrollment platforms, one-on-one consultations, and much more! If you would like more information on insurance carriers, network expansions, or supplemental coverages in your area, contact the professionals at Agent Pipeline via phone at 800-962-4693 or email us at info@agentpipeline.com. We are ready to help you succeed.

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