Jeff Gaston joins Dan and Mike to discuss the direction of the ACA market, insurance distribution, and technology-enabled agency support. They explore ICHRA opportunities, distinguish marketplace fraud from legitimate broker activity, and discuss pressure on Medicare and ACA agents. The conversation highlights customized CRM tools and practical support for producers adapting to a changing health insurance market.

In this episode

  • ACA market outlook
  • ICHRA opportunities
  • Marketplace fraud
  • Broker distribution
  • Agency technology support

Show notes

In Episode 125 of the Agent Boost Podcast, Mike sits down with Jeff, who just returned from the CMS Annual Marketplace Meeting in Baltimore, to break down everything brokers and agents need to know heading into this fall's open enrollment season.

This episode covers the real state of ACA in 2025, from what CMS leadership actually thinks about brokers, to breaking news about the three-way call finally going away, to a full carrier-by-carrier forecast for the coming open enrollment. Jeff shares firsthand intel from inside the CMS building, including what was discussed at the large agency roundtable that rarely gets talked about publicly. Mike adds his predictions on which ACA carriers are going big, why bronze plans and HSAs are about to become dominant, and why he believes the ACA market won't truly stabilize until 2028.

The conversation also digs into the very real pressure brokers are facing, overlapping Medicare AE and ACA OE deadlines, new consent form regulations, 75% QLE verification requirements, and the ongoing question of whether big tech is trying to eliminate brokers altogether. Plus, Dan and Jeff break down why 50% of agents have left the industry over the past two years and the two types of agents who are already gone.

If you're an ACA agent, a Medicare broker trying to cross-train, or an agency owner trying to set your team up for the most challenging open enrollment in years, this episode is essential listening.

Chapters

  • 0:00 Welcome & CMS Meeting Overview
  • 0:33 Inside the CMS Building in Baltimore
  • 3:31 ICHRA Update - Why It Still Isn't Working
  • 7:34 Dan's Canada Healthcare Story & What It Reveals About ICHRA
  • 9:14 Jeff's AI Panel at CMS - HIPAA, ChatGPT & What's Allowed
  • 12:01 Is CMS Trying to Eliminate Brokers?
  • 15:07 CMS Leadership Is Pro-Broker - Here's What They Actually Said
  • 17:18 Fraud vs. Real Brokers - Why They Keep Getting Lumped Together
  • 19:00 2.8 Million Ghost Enrollments & $20 Billion in Fraud Cleaned Up
  • 22:22 Large Agency Day - The NPN Problem Nobody Is Solving Fast Enough
  • 24:45 BREAKING: The Three-Way Call Is Going Away Before Open Enrollment
  • 27:51 Open Enrollment Shortened to Nov 1–Dec 31 (And Why That's a Problem)
  • 29:31 Medicare AE and ACA OE Running at the Same Time
  • 32:35 Mike: 50%+ of ACA Clients May Need a New Plan This Fall
  • 33:06 Bronze Plans & HSAs Are About to Explode - Here's Why
  • 33:50 75% QLE Verification - What It Means for Your Book of Business
  • 34:41 The Utah AI Data Center Story (Kevin O'Leary vs. All of Utah)
  • 38:16 ACA Was the Wild Wild West - How Far We've Come
  • 39:06 New CMS Consent Form Rules Coming - What You Need to Know
  • 40:45 What Every Broker Should Be Doing Right Now Before OE
  • 42:30 Go Health Files Chapter 11 - The End of the Churn & Burn Era
  • 44:08 Why You Need the Right FMO Heading Into This Open Enrollment
  • 47:48 Carrier Predictions: Oscar, Ambetter, United, CSSC & Who's Out
  • 50:27 Short-Term Medical Growth & When the ACA Market Finally Stabilizes
  • 51:49 50% of Agents Have Left the Industry - Who's Gone and Why
  • 54:26 ACA Spammers & Bad Actors Getting Eliminated
  • 55:01 Final Thoughts & What's Coming for Agent Boost