So, What Is the Affordable Care Act?

The ACA was created to make healthcare more accessible and affordable for individuals and small businesses. It provides financial assistance, like subsidies and premium tax credits, based on household income. The goal? To help those who don’t qualify for Medicaid and can’t afford private insurance get the coverage they need.

A Quick Look at the ACA’s Timeline

• 2006: Massachusetts, under Governor Mitt Romney, developed a healthcare model that influenced the ACA.
• 2010: The ACA officially became law, kicking off major healthcare reforms.
• 2013: The health insurance marketplace launched, making it easier for people to buy affordable coverage.

Who’s Eligible for ACA Coverage?

The ACA is designed for people with incomes between 100% and 400% of the federal poverty level. To qualify, you need to:

• Be a U.S. citizen or have lawful immigration status.
• Not have access to affordable employer-based insurance.
• Have a household income that falls within subsidy-eligible limits.

What’s Covered? The 10 Essential Health Benefits

All ACA-qualified health plans must include key benefits like:

• Hospital stays
• Maternity and newborn care
• Mental health services
• Preventative care
• And more! This ensures you get comprehensive coverage no matter what plan you choose.

When Can You Enroll?

• Open Enrollment: Typically runs from November 1 to December 31 (some states may have different deadlines).
• Special Enrollment Periods: If you experience major life changes—like moving, getting married, having a baby, or gaining legal U.S. residency—you might qualify to sign up outside the normal window.

Want to Sell ACA Plans? Here’s What You Need to Know

If you’re an agent looking to sell ACA plans, here’s what’s required:

• A life and health insurance license
• Completion of the Federally Facilitated Marketplace Training via CMS.gov
• Additional state-based certifications (if required)
• Access to platforms like HealthSherpa to make enrollments smoother

Getting Advanced Certification for State Exchanges

Some states run their own healthcare marketplaces, which means additional certification might be needed beyond the federal training. While it takes a little extra effort, being certified in multiple states can help expand your client base and ensure compliance.

Key Takeaways for Agents

• Get certified through CMS.gov and any necessary state exchanges.
• Use HealthSherpa or similar platforms to streamline enrollments.
• Stay on top of renewals and qualifying life events to keep your clients happy.

Wrapping It Up

We hope this guide gave you a clear picture of the ACA and what it takes to sell these plans. At Pinnacle Financial Services, we’re dedicated to helping agents succeed with training, resources, and support. Got questions? Want to collaborate? Reach out—we’re happy to help!

Stay in the Loop

For the latest updates on insurance trends and agent training, subscribe to our newsletter and follow our upcoming webinars. Thanks for joining us to learn about the ACA—let’s help more people get the coverage they need!

Watch the full webinar with our ACA Sales Director on YouTube: https://youtu.be/DQTFKcaIpA8

By Dave Gounis, ACA Sales Director at Pinnacle Financial Services