AI for ACA Health Insurance Lead Qualification.

ACA health insurance is the most seasonal vertical in the industry. During the 10-week Open Enrollment Period (OEP), your call volume triples overnight. You either hire a floor of seasonal screeners who take 3 weeks to train (half the OEP), or you run lean and leave millions in media margin on the table.

At $40-$60 per OEP transfer, you can't afford "junk connects"—people over 65 (Medicare), people with affordable employer coverage, or people calling about Medicaid.

Klariqo provides an automated pre-qual layer that handles the 90-second eligibility screening at scale, ensuring your licensed agents only pick up the phone when a billable transfer is on the line.

The AI manages the complex CMS eligibility rules and enrollment window logic required for ACA transfers.

Age & Basic Eligibility:

• Confirms the caller is under 65 (filters out Medicare-eligible).
• Verifies U.S. citizenship or lawful presence.
• Checks if they have affordable employer-sponsored coverage (disqualifier).

Enrollment Window (OEP vs SEP):

• During OEP (Nov 1 - Jan 15), filters for basic eligibility.
• During SEP months, screens for Qualifying Life Events (QLEs) like job loss, marriage, or moving to a new coverage area.

Financial & Situation:

• Confirms household size and estimated income to ensure they are within the subsidy range.
• Checks if the caller is currently on Medicaid (different enrollment process).

Transfer Readiness:

• Ensures the caller is ready to talk to a licensed health agent now.

You don't need to rebuild your dialer for OEP. Klariqo plugs directly into your VICIdial or SIP dialer as a remote extension.

1. Register the Extension: We provide a SIP address. Your admin adds it to your dialer like a remote human agent.
2. Set the Season: We configure the AI for OEP or SEP logic depending on the time of year.
3. Handle the Spike: Your dialer routes answered calls to the AI first. Only pre-screened, eligible leads get warm-transferred to your licensed agents.

Stop the "floor tax" on seasonal hiring. Handle the volume spike of 100,000+ minutes with zero training ramp or turnover.

Human rates include wages, dialer licenses, and management overhead.

By detecting answering machines in 4 seconds and instantly handling DNC requests, you protect your warmed numbers and ensure your licensed agents stay 100% utilized during the OEP crunch.

ACA marketing is heavily regulated by CMS. We ensure every call is 100% compliant.

• Non-Advisory Intake: The AI never discusses specific plans, premiums, or networks. It handles intake; your licensed agents handle the enrollment.
• Full Audit Trail: Dual-channel recordings and transcripts stored for the mandated 10 years—ready for any carrier or federal audit.
• TCPA & FCC: Full consent documentation and sub-500ms response times to ensure a natural, professional caller experience.

Read our full guide: AI for ACA Lead Qualification.

Health Insurance Agencies: Scale your OEP capacity without the overhead of seasonal screeners. Deliver only pre-qualified, subsidy-eligible transfers to your agents.

Pay-Per-Call Publishers: Improve your buyer's conversion rates and eliminate chargebacks. Deliver 100% billable ACA transfers and scale your OEP campaigns.

BPO Operators: Handle the massive OEP volume shifts without the hiring and training nightmare of seasonal staffing.