Enhanced Direct Enrollment (EDE)

EDE is a version of direct enrollment that allows consumers to apply for and enroll in individual health insurance coverage though the Federally-Facilitated Marketplace (FFM) and State-based Marketplaces that use the Federal Platform (SBM-FPs) without visiting HealthCare.gov. This pathway improves the user experience in shopping for, applying for, and enrolling in Marketplace coverage through third parties by allowing users to interact directly with approved EDE entities, which include QHP issuers and web-brokers, and complete all steps in the eligibility and enrollment process on a single website. The EDE pathway uses application programming interfaces (APIs) to transfer data between the Marketplace and approved EDE Entity websites.

Through API-based secure data transfers, the Marketplace determines a consumer’s eligibility for health coverage through either a Marketplace plan, including any advance payments of the premium tax credit and cost-sharing reductions if applicable, Medicaid, or the Children’s Health Insurance Program. Once determined to be eligible for a Marketplace plan, consumers can select and enroll in their choice of health plans. This process builds on years of work between the Centers for Medicare & Medicaid Services, issuers and other third-party partners seeking a more tailored eligibility and enrollment process on approved EDE Entities’ websites, which allows for consumers to apply for and enroll in a Marketplace plan, and manage their information year-round without the need to be redirected to HealthCare.gov or the Exchange call center.