On Wednesday, CMS announced a new enhanced direct-enrollment pathway for consumers to enroll in health insurance coverage through HealthCare.gov. The streamlined service is an extension of the existing direct enrollment pathway in use since 2013, and allows private sector partners to enroll consumers directly without going through the federal marketplace. Brokers who use this pathway will be able to use the portal to resolve application issues, or update items in a consumer’s application, such as address or name, without having to reenter all of the data in the application. NAHU has long advocated for a broker portal, but due to technology and budgetary constraints, an enhanced direct enrollment is the closest to a “broker portal” available for the federal marketplace.The enhanced platform streamlines the process that currently redirects consumers to HealthCare.gov to submit their application and receive an eligibility determination that then redirects to the partner’s website to complete plan selections and enrollment. Under the new fully integrated platform, consumers can apply, enroll, and manage their information through an approved partner website throughout the year. One of the biggest advantages of enhanced direct enrollment is that agents will be able to access their clients’ 1095 forms as well as any other notices that are sent to the enrollee, and consumers will also be able to download Exchange notices, get status updates, or follow up on actions they need to take directly through the partner’s website. This should alleviate many issues with income verification, submitting documents and renewals.
To be certified as an enhanced direct enrollment partner, entities are required to undergo audits to ensure compliance with nearly 300 security and privacy standards, as well as business audits to ensure systems will accurately deliver consumer information that is used to determine consumer eligibility. CMS will be continuously monitoring each partner to ensure they remain in compliance with these requirements.