Agency Action Plan
Many changes are coming to the ACA including a $5 premium for $0 passive renewals, the expiration of enhanced subsidies, and the end of the Special Enrollment Period for ≤ 150% FPL. This year more than ever, early preparation is critical to your agency’s success.
This Agency Action Plan will help returning agents and agencies navigate these changes by focusing on client retention using HealthSherpa ’s tools that streamline prioritization and renewal. We're here to help you every step of the way!
WHAT TO PLAN FOR
OE 2026 will be different. Expect to:
- Train and educate your agents on ACA changes, new workflows you will put in place, and new HealthSherpa features to help them navigate the ACA changes.
- Actively renew your entire book of business, including those clients that would passively renew (auto-renew) in a typical year.
- Spend more time on the enrollment process for most clients; longer enrollment times mean you might need more agent resources.
- Collect documents prior to Open Enrollment to increase efficiency after November 1st.
- Engage early with clients and create a dialog before OE begins.
RETENTION CHECKLIST FOR OE26
Train and educate your agents
Have your agents register for the webinar:
Everything you need to know for OEP 2026
FFM Training for plan year 2026 will be available later this summer. To learn more about HealthSherpa's FFM Training program where agents can earn free CEUs, visit our FFM certification page.
Share the Agent Action Plan with your agents.
Share the Agent Video Library for courses on important ACA topics and how to make the most of the HealthSherpa platform.
Help your agents learn more about the ACA changes for plan year 2026 and how to use HealthSherpa to navigate them on our ACA Changes Resource Center.
Review your book of business and prioritize outreach
This year, many consumers who would have passively renewed (auto-renewed) in previous years will need more support. Start your OE prep by reviewing your entire client list.
Educate your agents on how to identify their entire book, active and passive, and the importance of searching and claiming passive enrollments to encourage active renewals.
In HealthSherpa, you can view your client list along with DMIs, SVIs, payment status, and renewal factors to prioritize your outreach strategy for OE26:
- Agency Insights: Get enhanced reporting for deeper visibility into your agency book of business.
- Renewals section of Agency Tasks: Agents can see their full client list and filter by renewal factors to identify at-risk clients.
- New! Client follow-ups tab: Agents can see all follow-ups for each client in one place, making it easier to prioritize their work. Policies requiring action and with the soonest deadlines appear at the top of the list. Agents can also export a filtered list to perform and track outreach on specific follow-ups.
- NEW! Renewal factors have been added to help you identify clients affected by ACA changes, such as:
- Income near 150 FPL
- Income near 400 FPL
- $5 monthly payment
- Tax return access denied
- Failure to reconcile APTC
- Carrier exit
Refresher course on active vs passive renewals:
Begin consumer outreach early
It’s important to start engaging with your clients early. Doing so helps you educate and retain them, while also giving you the chance to collect information and documentation ahead of time. By having these details ready before November 1, you’ll free up more time during Open Enrollment to focus on completing enrollments.
During early outreach, explain that to remain covered in 2026 consumers may need to provide additional information and/or review plans.
- With HealthSherpa, you can collect and store information from consumers even without an active DMI or SVI.
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Learn about uploading follow-up documents
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Learn about managing consent with HealthSherpa
Live agent training:
Follow-up documentation and collecting documentation early
Start Intake now, save time during OE.
Agents can use the Share intake link to pre-collect the information needed for client renewals. Start sending clients secure links to share updated household details, income adjustments, uploaded documents, and even notes back to you. The secure Share intake link is available from the Clients page and Documents due tab.
All client submissions will appear on the Intake tab on your Clients page for easy tracking and organization.
Later, when you are renewing your consumer during OE, you'll be able to see the consumer's Intake form side-by-side with the application.
HealthSherpa's Renewal Intake form:
It’s important to start engaging with your clients early. Doing so helps you educate and retain them, while also giving you the chance to collect information and documentation ahead of time. By having these details ready before November 1, you’ll free up more time during Open Enrollment to focus on completing enrollments.
During early outreach, explain that to remain covered in 2026 consumers may need to provide additional information and/or review plans.
When Window Shopping begins, compare plans with your clients
This year, once Window Shopping opens, you’ll be able to see your consumer’s current plan next to the crosswalk plan for 2026.
This gives you a head start to review changes, compare options, and help your client make a decision so they’re ready to enroll as soon as Open Enrollment begins.
Once OEP begins, leverage renewal factors to prioritize your active renewals
Leverage the renewal factors and prioritization you established prior to OE to begin processing active renewals.
Renew consumers quickly
Renewals will be even faster this year with updates that allow you to:
- Go directly to sections of application that need changes.
- Skip lengthy clicks and CMS wait times during application for info that doesn’t change.
SEP CHANGES
The Special Enrollment Period is ending for clients with ≤150% FPL
- New clients may no longer be SEP eligible beginning in May, and they will need a qualifying life event (QLE) to enroll outside of OEP.
- Educate your team about all available QLEs so they are ready to explore alternative SEP opportunities with consumers.
Prepare to supply SEP pre-enrollment verification
- For SEP enrollments, expect to submit documentation to verify your client’s QLE.
- If the Marketplace can’t verify your client’s QLE, they may lose their SEP eligibility.
Read the SEP Overview to learn about:
- Special Enrollment Period (SEP)
- Qualifying Life Events (QLEs)
- DMIs and SVIs
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