AI for ACA Health Insurance Lead Qualification.

ACA health insurance enrollment is one of the most seasonal verticals in pay-per-call. Open Enrollment (November 1 - January 15) drives a massive spike in call volume. The rest of the year, only Special Enrollment Period qualifiers generate calls — and proving SEP eligibility requires screening.

During OEP, your licensed agents are drowning in calls from people who already have employer coverage, people over 65 who need Medicare instead, and people who want to complain about their existing plan but aren't actually switching. At $20-60 per qualified call, those dead-end conversations are expensive.

The staffing challenge mirrors Medicare: hire for peak and pay for idle seats 10 months of the year, or hire lean and miss volume during OEP. At $28-60 per transfer, the economics only work if most of your transferred calls actually result in enrollments.

ACA enrollment has specific regulatory requirements:

• CMS marketplace rules govern how ACA plans are marketed. The AI never discusses specific plan names, premiums, copays, or network details. It qualifies for enrollment eligibility and transfers to a licensed agent.
• Licensed agent requirement. Only licensed health insurance agents can discuss plan specifics and facilitate enrollment. The AI's role is pre-screening, not selling.
• Income and subsidy sensitivity. The AI asks about income for routing purposes but never promises specific subsidy amounts or premium levels.
• TCPA/DNC compliance. Standard. Dual-channel recording, AI disclosure, DNC flagging.
• Anti-steering rules. The AI doesn't recommend plans, carriers, or coverage levels. It screens for eligibility and routes to a licensed agent.