HealthSherpa Services

HealthSherpa is the largest ACA enrollment platform in the country and a CMS-approved Phase 3 Enhanced Direct Enrollment (EDE) vendor. HealthSherpa gives carriers a secure, proven infrastructure to distribute ACA-compliant health plans through agents, brokers, and direct-to-consumer channels.

The platform serves two interconnected ecosystems:

HealthSherpa lists your plans on the HealthSherpa Marketplace, the largest ACA distribution channel available through an EDE partner. Agents using HSMP can enroll consumers in your plans through the multi-carrier shopping experience. Carriers with a Marketplace agreement also gain access to Marketplace Pulse, a reporting tool showing enrollment share, market share trends, and plan performance down to the county level.

HealthSherpa offers a carrier specific White Label which is a fully branded on and off-exchange shopping and enrollment site built exclusively for your plans. It powers the complete ACA enrollment lifecycle for consumers and carrier agents:

Agents and consumers access your White Label through a custom URL in the format https://www.healthsherpa.com/?_agent_id=[your-carrier-slug]. Your Carrier Admin Dashboard provides a centralized hub to manage all of it, including agent management, branding, reporting, exports, and configuration. See the Getting Started Guide for Carrier Admins for a full walkthrough.

HealthSherpa supports off-exchange enrollment for carriers offering plans outside the subsidized marketplace, including consumer self-enrollment through your White Label and agent-driven enrollment on HSMP. If off-exchange is enabled for your carrier, your dashboard includes a dedicated Off-Exchange section for managing applications, SEP rules, and attestation documents.

A suite of APIs that connect 50+ ICHRA Administrators/Platforms to your plans through a single integration. Instead of building point-to-point connections for quoting, enrollment, policy status and payment with every ICHRA Administrator, you integrate once with HealthSherpa and gain access to the full, fast growing, ICHRA ecosystem.

HealthSherpa's Medicare platform brings the same streamlined enrollment experience to Medicare Advantage and MAPD plans. It is free for agents and agencies and supports shopping across 90+ quotable MA/MAPD carriers, AI-assisted prescription lookup, multi-upline management with one login, free APIs and webhooks for agency CRM integration, and real-time enrollment and production reporting. Learn more at medicare.healthsherpa.com.

A full enrollment, billing, and reconciliation back-office built specifically for the ACA. Built on ACA-native data architecture enriched with regulatory standards, MOps articulates the 834 processing from the exchanges ensuring all data anomalies are caught up stream and prevent any downstream claims system abrasion for our carrier partners. Understanding the value of creating financial predictability, MOps sends IC834s to the exchange every two hours to appropriately update the policy status that hinders on APTC payments. Our carriers have configurations available to ensure the outbound INC834 they receive from the MOps platform will ingest efficiency into their enrollment system. MOps delivers near-real-time binder processing and accurate monthly invoicing to keep members effectuated, while offering members a range of payment channels. Our reconciliation is the distinguishable piece of our product. Carriers who’ve converted have uncovered millions in unreconciled APTC over and under payments. Beyond the platform itself, we offer a back-office staffing model to manage end-to-end HICS processing, dispute resolution, regulatory reviews, and more. For more information, contact MOpsSales@HealthSherpa.com or your Account Manager.

A real-time feed of your policy and payment status data into the HealthSherpa Marketplace. This allows agents who are servicing your members to see effectuation and payment status without leaving our platform. Agents overwhelmingly prefer a single dashboard to manage their entire book. Carriers who don't provide this feed risk being the one plan an agent has to check somewhere else, which means less attention and less advocacy for your membership. Our data shows a dramatic increase in effectuation and retention for carrier partners who implement CPSF with us.

A dedicated team and monitoring system that proactively flags suspicious agent activity (such as unauthorized plan switching, unauthorized enrollments, mass re-enrollment patterns, and identity-based schemes), investigates it, and reports bad actors to CMS and state DOIs. FPU protects your membership and your loss ratio from fraudulent enrollment activity across the broker channel. FPU also partners with carriers on fraud-signal sharing, a two-way exchange of fraud indicators that sharpens detection on both sides.