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4 tales from the PPACA agent misery files

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“The Marketplace” — the Patient Protection and Affordable Care Act (PPACA) exchange system also known as — may be working now better than it was two years ago, but it’s no customer service paradise.

B. Ronnell Nolan, president of Health Agents for America (HAFA), shared tales from’s bad side this week, in an email interview.

Nolan started the group to give independent agents and brokers a louder voice in the national conversation about health policy, and PPACA implementation.

See also: PPACA World 2017: Don Goldmann looks ahead

The group organized an agent compensation petition, to at least give agents a chance to publicly, officially express their outrage about the recent waves of commission cuts hitting the individual health market.

Now, Nolan said, HAFA is trying to ramp up efforts to get managers to resolve lingering customer and producer service issues. For agents who are continuing to try to help clients with exchange coverage in spite of the commission cuts, the service problems are like acid on open wounds.

HAFA has had a hard time even getting Centers for Medicare & Medicaid Services (CMS) to send agents copies of the same innocuous newsletter that CMS sends to nonprofit exchange enrollee helper. Nolan gets some attention for HAFA simply by sharing the contents of the exchange helper newsletters with HAFA member agents.

Nolan said she has tried to talk to Kevin Counihan, the Centers for Medicare & Medicaid Services (CMS) who is billed as the Marketplace CEO.

“He says the right things, but no action,” Nolan said.

See also: What agent groups hate about proposed 2017 PPACA World rules

HAFA is now organizing a letter-writing campaign to try get state and federal legislators interested in the service problems.

For a look at a sampling of the stories from her agent misery files, read on. 


1. Debbie Pickett: Removing a spouse who turned 65 from an exchange plan account can be … difficult.

Debbie Pickett, an advisor who specializes in helping people who are eligible for Medicare, was working with a married couple that bought high-deductible coverage through The wife had a health savings account (HSA). The husband turned 65. Pickett tried to help the couple get the husband off the exchange plan coverage and keep the wife on the coverage. reps tried to make lives easier for themselves by having the wife replace the couple’s coverage with an entirely new individual policy.

“That would have made her deductible start all over again,” Pickett told Nolan.

 An exchange supervisor told the husband that correcting the error would take at least two weeks, Pickett said.

In other cases, Pickett said, she has to send the same documentation information again and again.

“This is getting ridiculous,” Pickett said. “They are losing information left and right … Who can help the people this affects? Yet we, as agents, are not needed. I am losing my cool. Loud scream here.”

See also: Agent: cancellation service is lousy


2. Jeff: The Marketplace transfers my accounts to other agents.

Health insurers are not paying exchange agents much these days.

Jeff, a HAFA member, told Nolan that he has found that representatives sometimes transfer responsibility for his exchange clients to other insurance agencies without any warning.

See also: How the PPACA exchange program still infuriates agents

PPACA plan metal levels

3. Frances Maane: The Marketplace puts people in unsuitable plans.

Frances Maane, an agent in Virginia, said she has low-income clients who are getting enrolled in exchange plans with high deductibles, and none of the PPACA cost-sharing reduction subsidy support meant to help low-income people cover plan out-of-pocket costs.

One client understood that she had such a high deductible only after the end of the open enrollment period, when she found she was pregnant.

“Based on her income, she will most likely qualify for Medicaid,” Maane said.

Medicaid lets applicants get covered year-round, eliminating the need for those applicants to qualify for a special enrollment period exemption. “So, she will be ‘one of the lucky ones’ who can get out of a mess that was created by the [Marketplace],” Maane said.

Icy window

4. Dave Bahl: There’s no visible agent board.

Dave Bahl, a Georgia agent, said he sees the same problems over and over, with some built in to rules.

Even though he is the agent of record on an exchange application, for example, the client still has to call the exchange to give him permission to speak on the client’s behalf.

If though he is the agent of record, the exchange sends correspondence only to the insured. The exchange never sends him copies.

“We need to know what’s going on,” Bahl said. “If something is missing, we need to know. If there’s a change of income, we need to know. If there’s a change of address, we need to know.”

Bahl also objected to the practice of CMS encouraging his exchange plan clients to re-enroll on their own during the open enrollment period, and cut him out of commissions. “I consider that to be stealing,” Bahl said.

Bahl said one way managers could improve the program’s relationship with agents and brokers would be to put agents and brokers on an advisory board, or, if it has such a board, to make more of an effort to let producers know about it.

“If [and] CMS are truly supposed to be working together with agents, then let’s work together,” Bahl said.

As it as now, Bahl said, “It feels that CMS and the site [and] systems in place go against the agent.”

See also:

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