Phases of Enhanced Direct Enrollment (EDE)

Not all phases of EDE are created equal.

Phases of Enhanced Direct Enrollment (EDE)2019-02-22T10:44:03+00:00

Here’s why each phase of EDE matters.

There are three phases of Enhanced Direct Enrollment (EDE) and not all EDE pathways are equal. While each phase eliminates the Healthcare.gov redirect for some, within phase 1 and phase 2, enrollment scenarios exist which still require a double-redirect. Phase 3 is the most robust implementation level and allows all complex household cases—including populations such as American Indians, non-tax-filers, and non-citizens—to take advantage of the new streamlined, single-site enrollment process. Beyond enrollment, consumers can also make changes to their plans during any special enrollment periods (SEP) triggered by life events without having to log into Healthcare.gov. EDE is a critical step in easing one of the biggest pain points of individual and family health insurance enrollment. GetInsured is one of the few companies working to complete all three phases of EDE implementation.

Let’s take a closer look at the three distinct available phases of Enhanced Direct Enrollment (EDE).

What is a Phase 1 Enhanced Direct Enrollment implementation?

A phase 1 implementation of Enhanced Direct Enrollment allows the most basic enrollment scenarios to be streamlined. Most others (i.e., pregnant consumer, etc.) will be completed through the traditional Healthcare.gov double-redirect pathway.

EDE Phase 1 Allows enrollment of:

  • Single Applicants
  • Married applicants
  • Non-pregnant applicants
  • Families without step or adopted children

What is a Phase 2 Enhanced Direct Enrollment implementation?

A phase 2 Enhanced Direct Enrollment implementation supports many enrollment scenarios not covered within phase 1. These scenarios provide a single-site enrollment experience for a wider population base, and are more complex but are not exhaustive. Some enrollment cases will still experience the double-redirect.

EDE Phase 2 Allows enrollment of:

  • Full-time student
  • Pregnant applicants
  • Non-U.S. citizens
  • Naturalized U.S. citizens
  • Missing SSN
  • Applicants with different names than the one on their SSN cards
  • Incarcerated applicants
  • Applicants previously in foster care
  • Stepchildren
  • Single Applicants
  • Married applicants
  • Non-pregnant applicants
  • Families without step or adopted children

What is a Phase 3 Enhanced Direct Enrollment implementation?

A phase 3 Enhanced Direct Enrollment Implementation supports every enrollment scenario without redirecting to Healthcare.gov, even the most complex. No need for a consumer to visit HealthCare.gov. Providing a smoother, more efficient, enrollment process for customers, carriers, and brokers.

EDE Phase 3 Allows enrollment of:

  • American Indian applicants
  • Alaskan Native applicants
  • Married applicants not filing taxes jointly
  • Dependants applicants who are not daughters, sons, or spouses
  • Full-time student
  • Pregnant applicants
  • Non-U.S. citizens
  • Naturalized U.S. citizens • Missing SSN
  • Applicants with different names than the one on their SSN cards
  • Incarcerated applicants
  • Applicants previously in foster care
  • Stepchildren
  • Single Applicants
  • Married applicants
  • Non-pregnant applicants
  • Families without step or adopted children

Which EDE phase is GetInsured implementing?

Phase 3. GetInsured was a pioneering participant in the early CMS discussions on how to best build an EDE pathway. Using the company’s best-in-class technology, while still adhering to CMS regulations and best practices for consumer experience and security, GetInsured’s phase 3 solution will, upon approval, allow carriers, brokers and State-Based Marketplaces across the country to easily utilize EDE during the six-week FFM open enrollment period.

How much will Enhanced Direct Enrollment Cost?

EDE is free for brokers utilizing our broker platform; this includes EDE powered quoting and enrollments, 1095 management, life changes, special enrollment period (SEP) enrollments, and renewals. As an EDE vendor, GetInsured provides custom solutions for State-Based Marketplaces and Carriers. 

3 Phases of EDE

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