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Life Health > Health Insurance > Your Practice

Brokers and the Exchanges: Health Plan Sommeliers?

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No matter what happens to the Patient Protection and Affordable Care Act of 2010 (2010), the trend toward individual and small group health coverage sales shifting to exchanges likely will continue.

Ross Stromberg, a health care advisor in the San Francisco office of PricewaterhouseCoopers L.L.P., gave that assessment today during an interview.

PricewaterhouseCoopers today released a collection of health care market predictions for 2012.

One is that that the new exchanges created by the Patient Protection and Affordable Care Act of 2010 (PPACA) will create both opportunities and challenges for health insurance players.

If PPACA takes effect as written and works as drafters expect, the PPACA exchanges are supposed to create “one stop shopping” services for individuals and small groups using the new tax credit subsidies created by PPACA.

Policymakers expect the exchanges to serve a significant but relatively small percentage of health coverage buyers, but Stromberg said that, in many cases, new and expanded private exchange programs could serve many of the buyers not shopping at the PPACA exchanges.

Blue Cross and Blue Shield carriers are showing increasing interest in selling through exchanges, Stromberg said.

Private exchanges could end up playing a bigger role than many expect because, in many states, “the state insurance exchanges are having a slow start,” Stromberg said.

For the most part, if more consumers get health coverage through either private or PPACA exchanges rather than through small employer-sponsored plans, “brokers will likely play a less important role in guiding the consumer throughout that process,” Stromberg said.

But Stromberg noted that consumers could end up depending heavily on thick, complicated guides full of government-approved “quality rating data.” Now, for example, private Medicare plans are rated on a 5-star quality scale.

Brokers could stay in the advisory game by showing consumers that they are a better source of plan quality and feature information than the official guides, Stromberg said.

Zagat’s gives consumers information about restaurants, and sommeliers give consumers informations about which fine wine to drink with their dinners.

If brokers can show they are to choosing health coverage what a trusted sommelier is to choosing a wine, consumers may find those brokers to be worth staying with, Stromberg said.


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