2 Ways You Can Help Under-65 Clients Find Individual Health Insurance

Dec 7, 2023 6 min read

Today’s individual health insurance market has evolved into a more stable, profitable and promising market since the Affordable Care Act (ACA) started providing subsidized health insurance in 2014. This friendlier selling environment comes just as demand surges for under-65 plans due in part to the extension of federal subsidies through 2025.

The opportunity to help under-65 prospects, existing clients and their family members get suitable individual health insurance is huge! Coming off a record-high enrollment season, the ACA Marketplace is poised for even more explosive growth. The historic Medicaid redetermination underway will potentially drive more than 15 million people into the under-65 individual health insurance market.

Potential clients include those:

Whose income could qualify their dependents for ACA Marketplace subsidies, making the ACA plan more affordable than their employer-sponsored group coverage¹
Who are retiring early and need a plan before Medicare starts at age 65
Whose spouse is under 65 and needs health coverage
With a dependent who is aging out of a parent’s company-sponsored group plan and needs an affordable plan

Who are not eligible for their employer’s benefits
Who are leaving their job and want to explore options other than those available through the Consolidated Omnibus Budget Reconciliation Act (COBRA)

Also of note:

You probably already know how hard it is to find policies that cover for pregnancy and those with preexisting conditions. However, both are covered under ACA plan options.

Whether you decide to refer clients for help or sell plans yourself, this is a year-round opportunity that can supplement your other lines of business.

2 Ways to Help Clients and Grow Your Business

No. 1 – Sell

Learn more about O’Neill Marketing, a general agency that’s an ACA Marketplace leader and Senior Market Sales^® (SMS) partner, to access:

All major ACA carriers
Proprietary agent portal and quoting and enrollment tools
Agent empowerment and marketing resources
Back-office support
Solid commissions

No. 2 – Refer

Refer your clients to Medicare MarketPlace^® to speak with a licensed insurance agent. Because they specialize in ACA plans, they can:

Assess your client’s needs
See if the client or their dependents qualify for ACA Marketplace subsidies
Find suitable, affordable plan options
Compare plans
Enroll them in a plan

Refer clients by suggesting they call 1.866.218.2064 to speak with a licensed insurance agent.

Additional helpful information:

The ACA Marketplace has an open enrollment period when people can sign up for health insurance or make changes to their coverage, but many life events can trigger a special enrollment period (SEP), making year-round enrollment likely.
The dates for the federal ACA Marketplace open enrollment can change slightly each year — for 2024 plans, it is Nov. 1, 2023, through Jan. 15, 2024.² A few states with their own marketplaces have different date ranges.

Here are some common life events that can qualify for an SEP.³

Loss of health coverage:

Losing existing health coverage, including job-based, individual and student plans
Losing eligibility for Medicare, Medicaid or the Children’s Health Insurance Program (CHIP)
Aging out of a parent’s plan

Changes in household:

Getting married
Getting divorced
Having a baby or adopting a child
Death in the family

Changes in residence:

Moving to a different ZIP code, county or state
A student moving to or from the place they attend school
A seasonal worker moving to or from the place where they live and work
Moving to or from a shelter or other transitional housing

Other qualifying events:

Changes in income that affect the coverage they qualify for
Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
Becoming a citizen of the United States
Leaving incarceration
AmeriCorps members starting or ending their service
Income is less than 150% of the federal poverty level (FPL)

To learn more about the opportunity and how SMS can help, fill out this form or call 1.888.747.3810 to speak with a Med Solutions marketing consultant.

A Little More About SMS

SMS represents top Medicare Supplement, Medicare Advantage, annuity, life, long-term care, and travel insurance carriers in all 50 states. More than 71,000 independent insurance agents rely on SMS for proprietary technology, competitive insurance products, and expert training and service to help them leverage their time, make more money, and put their business in a position of distinction. Founded in 1982, SMS is headquartered in Omaha, Nebraska. In 2020, SMS joined the Alliant Insurance Services family of companies. Call 1.800.786.5566 for more information.

¹The federal government recently changed who is eligible for Marketplace subsidies and how subsidies are calculated. Dependents who previously were ineligible due to a worker’s income may now qualify.

²In most states.

³SEPs run for 60-day periods beginning with the date of the qualifying event. This list does not exhaustive. Encourage clients to call AIHS to find out if they are eligible for an SEP.

For Licensed Insurance Agent/Advisor Use Only. Not for General Public.