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Over at the Wiley Online Library, Aleka Gurel, Director of Government Affairs at HealthSherpa, has published an excellent, in-the-weeds analysis of the history & impact of private insurance brokers & agents on ACA marketplace (on exchange) enrollment.
Here's an excerpt (note that this website is actually among the data sources she cites):
Three key takeaways from the CMS snapshot of the first 18 days of Open Enrollment:
1. HealthSherpa is up nearly 70% year over year, with over 2.4 million people enrolled.
2. The entire Federal Marketplace is up 40% year over year, with almost 4.1 million people covered in the same time frame.
3. We estimate that 2 out of 3 new enrollments in Federal Marketplace states - people newly covered by the ACA - came through HealthSherpa.
Policies: 1.79M
Covered Lives: 2.43M
At the time, 2.43 million enrollees via Sherpa and their affiliates represented roughly 60% of all HC.gov enrollees for the first 18 days of the 2024 ACA Open Enrollment Period.
HealthSherpa continues to be the largest private channel for ACA enrollments in the US, insuring over 5 million people for 2023 and growing more than 50% year over year
In its strongest season yet, HealthSherpa has enrolled more than 5 million people in Plan Year 2023 coverage and enrolled HALF of all new Affordable Care Act enrollees in Federally Facilitated Marketplace (FFM) states during Open Enrollment. HealthSherpa now accounts for 35% of all FFM enrollments and volume grew more than 50% year over year, far outpacing the FFM as a whole which grew only 13% (1).
Enhanced direct enrollment (EDE) is a new pathway for consumers to enroll in health insurance coverage through the Federally-facilitated Exchange. This pathway allows CMS to partner with the private sector to provide a more user-friendly and seamless enrollment experience for consumers by allowing them to apply for and enroll in an Exchange plan directly through an approved issuer or web-broker without the need to be redirected to HealthCare.gov or contact the Exchange Call Center.
Enhanced direct enrollment (EDE) is a new pathway for consumers to enroll in health insurance coverage through the Federally-facilitated Exchange. This pathway allows CMS to partner with the private sector to provide a more user-friendly and seamless enrollment experience for consumers by allowing them to apply for and enroll in an Exchange plan directly through an approved issuer or web-broker without the need to be redirected to HealthCare.gov or contact the Exchange Call Center.
In short, EDEs are basically a private version of HealthCare.Gov which are authorized by the federal government to hook directly into the HC.gov back end. This means that people who enroll via an EDE website are enrolling in on-exchange ACA coverage (including ACA financial subsidies as appropriate); they're just doing so via a 3rd party web interface. There's actually several dozen different EDEs, several of which have advertised on this site.
The Affordable Care Act includes a long list of codified instructions about what's required under the law. However, like any major piece of legislation, many of the specific details are left up to the agency responsible for implementing the law.
While the PPACA is itself a lengthy document, it would have to be several times longer yet in order to cover every conceivable detail involved in operating the ACA exchanges, Medicaid expansion and so forth. The major provisions of the ACA fall under the Department of Health & Human Services (HHS), and within that, the Centers for Medicare & Medicaid (CMS)
Every year, CMS issues a long, wonky document called the Notice of Benefit & Payment Parameters (NBPP) for the Affordable Care Act. This is basically a list of tweaks to some of the specifics of how the ACA is actually implemented.
