Agent Action Plan
Big changes are ahead for the ACA, and as you get ready for plan year 2026, a little early prep can make a big difference.
That’s why we created this Agent Action Plan: to help you stay ahead of the curve, keep your clients covered, and make the most of the new tools in HealthSherpa. It’s designed to support you through every step of your pre-OEP workflow, so you can reconnect with your book of business, work more efficiently, and set yourself up for a successful enrollment season.
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WHAT TO PLAN FOR
OE 2026 will be different. Expect to:
- 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
- Collect documentation prior to Open Enrollment
- Engage early with clients and create a dialog before OE begins
Agent training and education resources:
RETENTION CHECKLIST FOR OE26
Review your book of business and prioritize outreach
This year, many consumers who would have passively renewed in previous years will need more support. Start your OE prep by reviewing your entire client list.
In HealthSherpa, you can view your client list along with DMIs, SVIs, payment status, and renewal factors to prioritize your outreach strategy for OE26:
- Use the Renewals tab to see a real-time list of your clients, along with their renewal status and renewal risk factors.
- New! Client follow-ups tab: View your client list and all followups in one place for easier prioritization. Policies with actions needed and with the soonest deadline will be at the top of the list.
- New! Renewal factors have been added to help you identify clients affected by ACA changes, such as:
- Income near 150 FPL
- $5 monthly payment
- Tax return access denied
- Failure to reconcile APTC
- Carrier exi
HealthSherpa's Client follow-ups tab:
Refresher course on active vs passive renewals:
Begin consumer outreach early
It's important to start engaging with your clients early to increase the chances of educating and retaining your clients. Explain that to remain covered in 2026 they may need to provide additional information and/or review plans.
Resources to engage with your clients include consumer education materials, custom flyers, email templates, consumer readiness checklists and even social media templates.
Upload documents early and easily. Collect and store initial consent, required documentation, and client updates directly in HealthSherpa before Open Enrollment even begins, streamlining your workflow and avoiding delays once OE is underway.
- Learn about uploading follow-up documents and collecting and storing client information on HealthSherpa
- Learn about managing consent with HealthSherpa
- Know which documents are accepted to verify a loss of coverage.
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 being 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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