FACT SHEET

FOR IMMEDIATE RELEASENovember 28, 2018

Contact: CMS Media Relations
(202) 690-6145 | CMS Media Inquiries

Enhanced Direct Enrollment Pathway for Health Insurance Exchange Coverage

The Centers for Medicare & Medicaid Services (CMS) developed a new ‘enhanced’ direct enrollment pathway for consumers to enroll in health insurance coverage through the Federally-facilitated Exchange. This new 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

The new enhanced direct enrollment pathway improves upon the current direct enrollment pathway which has been in place since 2013. Both pathways allows issuers, agents and brokers, and other third parties certified to sell health insurance (known as web brokers) to assist consumers applying for and enrolling in an Exchange plan. The current direct enrollment pathway requires consumers to be redirected to HealthCare.gov to submit their application and receive an eligibility determination from the Exchange. From there, they are redirected back to the partner’s website to complete plan selections and enrollment. This process made for a poor consumer experience and proved burdensome to those private partners assisting consumers.

Enhanced direct enrollment provides a range of custom features and capabilities that allow consumers to apply, enroll, and manage their information through an approved partner website throughout the year. The enrollment partner’s website will connect to HealthCare.govin a manner that is invisible to the consumer. Through this new fully integrated platform, consumers and agents and brokers assisting consumers will be able to go directly to the approved enrollment partner’s website to for the entire application and enrollment experience without being redirected to HealthCare.gov. In addition, consumers will be able download Exchange notices, get status updates, or follow up on actions they need to take directly through the partner’s website. This great new opportunity enables the private sector to come up with innovative ways to create a uniquely tailored end-to-end user experience.

PRIVACY AND SECURITY

The safety and security of consumer information is our number one priority. Enhanced direct enrollment partners are required to undergo rigorous audits to ensure compliance with strict privacy and security controls prior to being certified to use this new platform. CMS also requires business audits, to make sure that partners’ systems will accurately deliver consumer information that the Exchange will use to determine the consumer’s eligibility. CMS reviews the results of the audits to ensure compliance with the nearly 300 CMS security and privacy standards. CMS continuously monitors each partner to ensure they remain in compliance with CMS requirements.

IMPLEMENTATION

CMS anticipates that the use of this pathway will continue to grow beyond this Open Enrollment Period as more partners are approved and begin offering enhanced direct enrollment functionality. The time at which each partner will begin providing enhanced direct enrollment capability depends on when each partner finalizes its preparations and is approved. As soon as a partner’s platform goes live, consumers will be able to apply for and enroll in an Exchange plan directly through the approved partner’s website. As CMS approves partner websites to go live, CMS will maintain an updated list on www.cms.gov/CCIIO.

CMS looks forward to continuing to work with private partners to make sure that enhanced direct enrollment pathways are accessible, secure, and meets our goal of improving the consumer experience by offering consumers more ways to apply, enroll, and manage their coverage.

Consumers can visit https://www.healthcare.gov/direct-enrollment/ for more information on how to get health coverage through approved enrollment partner websites.

For frequently asked questions about enhanced direct enrollment, visit: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/Downloads/FAQs-EDE.pdf