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Health exchange: High-income prospects more likely to buy through Web

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In New York state, brokers may have trouble expanding individual health insurance sales to the most attractive prospects.

Brokers are already serving a high percentage of the consumers who are paying the full list price for public exchange plan coverage, and high-income exchange plan users are much likely to buy their coverage through the Web, without in-person help.

Managers of NY State of Health, New York’s state-based Patient Protection and Affordable Care Act (PPACA) public exchange, have included data on 2015 exchange qualified health plan (QHP) distribution channel performance in a new report on the 2015 open enrollment period.

The 2015 open enrollment period started Nov. 15, 2014, and officially ended Feb. 15, 2015. The 2016 open enrollment period is set to start Nov. 1, 2015 and end Jan. 31, 2016.

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NY State of Health enrolled 2.1 million people this year, up from 960,762 in 2014. Exchange enrollment in Medicaid and Children’s Health Insurance Program (CHIP) plans increased to 1.7 million, from 590,000. And enrollment in exchange qualified health plans (QHPs) — plans from commercial health insurers  — increased to 415,000 from 371,000.

The exchange worked with more than 11,000 nonprofit and for-profit in-person helpers for the 2015 enrollment period. That figure includes 5,239 insurance brokers, 765 nonprofit navigators, and 5,384 certified application counselors (CACs) and facilitated enrollers.

Brokers helped just 4 percent of all exchange users, in part because they advised only 2 percent of the users who signed up for Medicaid. But brokers served 14 percent of the New York exchange users who bought commercial qualified health plan (QHP) coverage, either with or without a PPACA premium subsidy tax credit.

About 42 percent of all QHP buyers were able to complete the entire transaction on the Web, compared with just 19 percent of the Medicaid enrollees.

Exchange managers found a similar Web gap between the moderate-income consumers who used PPACA tax credits to buy their QHP coverage and the high-income consumers who had to pay the full price for coverage.

Brokers helped 52 percent of the high-income buyers who had in-person help, compared with just 27 percent of the moderate-income buyers who had in-person help.

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But the high-income QHP buyers weren’t all that likely to need in-person help: About 66 percent did everything online, compared with just 33 percent of the moderate-income QHP buyers.

The numbers suggest that brokers may already be serving a high percentage of the high-income individual health prospects in New York state who want in-person help with applying for insurance.