Understanding Marketplace Compensation for Agents and Brokers
This post was originally published by the Centers for Medicare and Medicaid Services.
Agents and brokers who participate in the Federally-facilitated Marketplace (FFM) receive compensation directly from affiliated qualified health plan (QHP) issuers in accordance with their agreements with those issuers and any applicable state requirements. The Marketplace does not play a role in arranging appointments, setting compensation levels, or ensuring that compensation is paid to agents and brokers. Contact your state department of insurance for more information about state licensure and appointment standards.
To get compensated for actively assisting a consumer with enrollment in a Marketplace QHP, you must:
- Be appointed with the QHP issuer in accordance with state law;
- Have completed FFM registration (including required training) for the applicable plan year at the time of enrollment;
- Read and sign all applicable Marketplace agreements; and
- Be licensed with an active health-related line of authority in the state(s) where the QHP is offered through the Marketplace.
The Marketplace will transmit agents’ and brokers’ identifying information included on the application with the enrollment to QHP issuers on the Marketplace enrollment transactions (called an “834”). In cases where an FFM-registered agent or broker receives compensation through a third-party entity, such as an agency or brokerage that is registered with the FFM, the agent or broker may work with the QHP issuer to appropriately direct compensation based on the National Producer Number (NPN) included on the 834.
Regardless of the pathway used to assist with Marketplace enrollments, you should work with each consumer to make sure that your correct identifying information (name and NPN) is included on Marketplace enrollment transactions you assisted with. This information must be correct for the Marketplace to associate the transaction with you.
If you believe your NPN was accidentally or intentionally removed from a consumer’s application, you can submit the Application ID with a description of the problem (without consumer personally identifiable information) to the Agent/Broker Email Help Desk at FFMProducer-AssisterHelpDesk@cms.hhs.gov for CMS to investigate the issue. In some cases, CMS may not be able to resolve your issue. You can always contact the QHP issuer directly to discuss the situation. When contacting the issuer, you will need to provide evidence that you are the Broker of Record (BOR) for a specific FFM enrollment.
Contact your Cornerstone representative with any questions.
