- A live transfer is somebody else’s screening script, bought sight unseen. That script, not the call, is the product.
- The income question that disqualifies a caller flips depending on the state. In the 41 states including the District of Columbia that expanded Medicaid, a caller under the expansion line goes to Medicaid instead of a Marketplace plan, according to KFF.
- In Florida and Texas, the two largest Marketplace states by plan selections per CMS, that same caller may be your best prospect. One national script is wrong in both directions.
- A screen with no household size cannot find either edge of the subsidy band, which the IRS sets at 100 to 400 percent of the poverty line.
- Ask for the screener’s script in writing before you send money.
Quick answers: What is an ACA live transfer? · Are live transfers better than inbound ACA calls? · How much do ACA live transfers cost? · Can I buy ACA transfers outside open enrollment? · What should I put in a screening brief?
On a live transfer you are not buying a lead. You are buying the screening script a vendor handed a call center, and you are buying it sight unseen.
That distinction is the whole decision. Get the script wrong and you pay full price for people who cannot buy what you sell.
On a transfer, you inherit somebody else’s screening
An inbound ACA call and a live transfer arrive looking identical. A human is on the line and they want coverage. The difference sits upstream.
On an inbound call, the caller responded to something and dialed. Your own agent asks the disqualifying questions and hangs up on the misses, so the waste is a few minutes of talk time. You pay for your own screening in agent hours instead of in invoices. We covered how that math works on the buy side of inbound call pricing.
On a transfer, a call center already spoke to the caller and made the judgment for you. By the time your phone rings, the decision is made and the invoice is running. If the screener was never told to check the income question, they will pass those callers to you all day. Every one of them is billable.
That is the honest trade. Transfers buy predictable seat utilization and someone else’s dialing cost. You give up control of the decision that matters most.
So the general buy-side math on live transfers understates the risk in health. Elsewhere a bad screen wastes talk time. In ACA it sends you people who cannot enroll today, however good your agent is.
Buy the same unit in HVAC and the screen turns on tenancy and service area instead. That is why the HVAC live transfer screening spec reads nothing like this one.
The income line is not the same line in every state
Here is the part the vendor pages skip.
The Affordable Care Act expanded Medicaid to adults earning up to 138 percent of the federal poverty level, according to KFF. That line is $22,025 for one adult in 2026, and 41 states including the District of Columbia adopted the expansion, KFF reports. In those states a caller under that line qualifies for Medicaid, so they are not shopping for a subsidized Marketplace plan.
Ten states never adopted it. There, KFF reports that uninsured adults earning too much for Medicaid and too little for Marketplace subsidies fall into a coverage gap instead. Texas sets the lowest bar for parents in the country, denying Medicaid to a parent in a family of three earning more than $342 per month, according to KFF.
Now put that next to where the volume is. CMS counted 4,474,300 Marketplace plan selections in Florida and 4,113,465 in Texas for 2026, the two largest of any state, in its open enrollment snapshot. Neither state expanded Medicaid.
So your most important screening question behaves in opposite directions across your two biggest markets.
| Caller’s household income | Expansion state (41 incl. DC) | Non-expansion state (10, includes FL and TX) | What the buyer should do |
|---|---|---|---|
| Below the poverty level | Medicaid eligible, so no subsidized Marketplace plan (KFF, 2026) | Coverage gap: no Medicaid and no Marketplace subsidy (KFF, 2026) | Reject in both. This transfer should never have been billed. |
| Between the poverty level and 138 percent of it, up to $22,025 for one adult | Medicaid eligible, so no subsidized Marketplace plan (KFF, 2026) | Subsidy eligible, and often your strongest prospect (KFF, 2026) | Route by state. A national script gets this backwards. |
| Between 138 and 400 percent of the poverty level | Marketplace subsidy eligible (IRS) | Marketplace subsidy eligible (IRS) | Accept in both. |
| Above 400 percent of the poverty level | No premium tax credit (IRS) | No premium tax credit (IRS) | Reject in both, unless you sell unsubsidized plans. |
Read the second row twice. The same answer to the same question means “reject” in Ohio and “best call of the day” in Texas. A vendor running one national script is either sending you unsellable callers in expansion states, or screening out your best prospects in Florida and Texas. Both errors are invisible on an invoice.
The top of the band moved this year too. The IRS sets premium tax credit eligibility at 100 to 400 percent of the poverty line, and Congress lifted that ceiling only for tax years 2021 through 2025. KFF confirms 2026 is the first year since 2020 without the enhanced credits, and enrollment is down.
What a real vendor screen actually looks like
One vendor publishes its screen.
SPRK Technologies states on its ACA live transfer page that every prospect is screened on three criteria: age 64 and under, income less than $58K annually, and state and zip verification.
Read that income test against the table above. It is a flat national number with no household size and no lower bound.
The poverty line is not one number. KFF puts it at $15,650 for a single adult in 2026 and $32,150 for a family of four. A screen that never asks household size cannot locate either edge of the subsidy band.
Worse, an income test with no floor selects for the callers you cannot sell. In an expansion state, any caller below the Medicaid line clears that vendor’s income screen comfortably, and is Medicaid eligible, so they cannot buy a subsidized Marketplace plan at all. The screen is not failing at the margin. It is pointed the wrong way.
The calendar decides whether anyone can enroll
The second rejection ground is the date.
Open enrollment for 2026 coverage ran from November 1, 2025 to January 15, 2026, per CMS. Outside that window, HealthCare.gov is explicit on its Special Enrollment Period page: a person can only enroll in or change Marketplace plans if they qualify for a Special Enrollment Period. That generally means a qualifying life event in the past 60 days, such as losing coverage, moving, marrying, or having a child.
It goes further. HealthCare.gov states that a consumer who does not provide acceptable documents about losing coverage will not qualify at all.
Two things follow. Off-season, “has anything changed recently” is not optional, it is the question. And in season, transfers arrive fastest when your agents are most stretched. A transfer nobody picks up is usually still one you bought, so check the contract for a no-answer credit. Cap daily volume against seats you have rostered, not against appetite.
The screening brief, written out
This is the document to send. Give it to the vendor before the first invoice and ask them to confirm their screener asks these, in this order, in these words.
- “Are you the person who would be on the policy?” If not, get the decision maker on the line or end the call. A transfer to somebody’s adult child is not a prospect.
- “What state do you live in?” Asked first, because it changes the meaning of every answer that follows. It also decides whether you are licensed and appointed to write the business at all.
- “How many people are in your household, including yourself?” Household size sets the poverty threshold. Income alone is meaningless without it.
- “Roughly what does your household expect to earn this year, before taxes?” Expected annual household income. Not last year’s, and not take-home pay. Read it against the table above, both edges, not just the top.
- “Do you have health coverage right now, and if so, through whom?” Someone already on Medicaid or an employer plan is a different conversation. Someone who just lost coverage has a qualifying event.
- “Has anything changed in the last 60 days: a job, a move, a marriage, a birth, or losing coverage?” Off-season this is the gate. In season it still flags the documents the applicant will need.
Then one instruction, which is the part vendors resist. Do not transfer on a “maybe” for the state, income or life-event questions. A screener paid per transfer will resolve ambiguity in favor of transferring. That is the broken incentive at the heart of this product, and it is why the script has to say in writing that an unresolved answer is a no.
Test the published numbers before you scale
Vendor pages quote conversion rates without naming the denominator. SPRK Technologies advertises an average conversion rate above 62 percent on its ACA live transfer page, without saying conversion to what. A quoted rate, a submitted application and an effectuated policy are three different events with very different economics.
So define the denominator yourself, in the contract, before you buy volume.
Then run a bounded pilot. Size the block off your own seat count: two days of what your rostered agents can actually work. Measure four things and nothing else:
- How many transfers reached a licensed agent at all.
- How many were eligible to enroll under both tests above.
- How many submitted an application.
- How many were still active after the first premium cleared.
Decide the eligibility rate you will walk away at before the first call rings, not after.
Published ranges are a sanity check on the invoice, not a target. OneLife Marketing Solutions puts the market range for ACA inbound calls at $32 to $85 and for live transfers across all verticals at $45 to $160, in its 2026 lead pricing guide. Against that, SPRK’s published ACA transfer pricing of $36 down to $33 per call by volume, on its own page, sits at the bottom of the range for an ordinary ACA call. A screened transfer priced like an unscreened call should make you ask what the screen consists of. Check the add-ons too: that same page requires a dialer subscription at $60 per user each month on every package.
For where transfers sit against shared and exclusive records, see our U65 health insurance leads buyer guide and the difference between U65 and ACA lead types. We also broke down who really dials a live transfer lead.
Frequently Asked Questions
What is an ACA live transfer?
A call center contacts a consumer, screens them against a script, then warm transfers the live caller to a licensed agent who pays per transfer. The difference from an inbound call is that the screening happened before you were connected, using criteria you did not write.
Are live transfers better than inbound ACA calls?
Neither wins outright. Transfers win when you have licensed agents sitting idle and want predictable seat utilization. Inbound calls win when you would rather control the screen yourself and can live with more variable volume. The deciding factor is whether you trust the vendor’s script more than your own agents’ time.
How much do ACA live transfers cost?
OneLife Marketing Solutions puts the market range for ACA inbound calls at $32 to $85 and for all-vertical live transfers at $45 to $160 in its 2026 pricing guide. SPRK Technologies publishes ACA transfer packages from $36 down to $33 per call by volume on its own site. Ask what screening is included at the quoted price, because that is what differs.
Can I buy ACA transfers outside open enrollment?
Yes, but only callers with a qualifying life event can enroll. HealthCare.gov states that outside the annual window you can only enroll in or change Marketplace plans with a Special Enrollment Period, and that acceptable documents may be required to confirm it, on its Special Enrollment Period page. Off-season, a vendor that does not screen for a qualifying event is selling you callers who cannot buy.
What should I put in a screening brief?
Six questions: who would be on the policy, what state, household size, expected annual household income, current coverage, and any change in the last 60 days. Plus one rule. An unresolved answer is a no, not a transfer.
What to ask for before the first invoice
Before you agree to volume, ask the vendor for three documents:
- The screener’s script, as it is actually read on the call.
- The daily transfer cap they will hold you to.
- A written definition of the conversion event behind any performance claim they used to win your business.
None of that costs anything. All of it is refusable. A vendor who will not put the script in writing has priced it for you, before you spend a dollar.
