Managers of HealthCare.gov have confirmed that they are leaving agent and broker compensation concerns out of efforts to help exchange users facing potential coverage gaps.
HealthCare.gov has developed an “auto re-enrollment” process for users affected by issuer decisions to drop specific health plans. If a consumer’s plan goes away, and the consumer fails to choose a replacement plan, the exchange system will try to move the consumer, or move the consumer into a similar plan from the same issuer. HealthCare.gov calls that process “crosswalking.”
If an issuer has left the HealthCare.gov system in the consumer’s areas, the exchange will try to crosswalk the consumer into a similar plan from a different issuer.
Some agents and brokers who have struggled to help consumers sign up for HealthCare.gov coverage have been wondering whether the exchange will do anything to increase the odds that the replacement plans will pay commissions to the agents or brokers of record.
HealthCare.gov managers said Nov. 16, during a private conference call with HealthCare.gov agents and brokers, that they will not.
HealthCare.gov “does not take into consideration whether an issuer pays a commission when auto-renewing consumers,” exchange managers said, according to a written version of the answer posted on an exchange technical assistance website.
The HealthCare.gov managers talked about one rule that could help exchange plan agents: If HealthCare.gov moves an agent’s clients into new plans, and the issuers of the new plans do pay commissions, the issuers of the new plans can pay the commissions to the agent even if the agent’s exchange registration has expired.
Managers said, in a separate meeting slidedeck, that they have planned three major auto re-enrollment waves.
The re-enrollment waves
The first, which started Oct. 12, affected enrollees who were being moved into new plans from the same issuer.
The second, which started Nov. 21, affected enrollees who were being moved into new plans from a different issuer.
The third, which will take place this month, will affect enrollees with a variety of more complicated problems, such as problems with clearing up questions about tax credit subsidy applications.
When HealthCare.gov moves enrollees into new plans, HealthCare.gov will “generally” send the agents’ producer numbers to the issuers of the new plans, managers said.
“Enrollment information will not be visible in consumers’ accounts until Dec. 16,” managers said.
Open enrollment for 2017 started Nov. 1 and is set to end Jan. 31.
Drafters of the Affordable Care Act created the public health insurance exchange system, or web-based health insurance supermarket, in an effort to cut the average ratio of claims per enrollee enough to make selling coverage without medical underwriting financially sustainable.
ACA drafters were hoping the exchange system, and exchange system premium subsidies, would tempt enough young, healthy people to buy coverage to offset the cost of requiring insurers to cover people with cancer, severe heart disease, hemophilia and liver failure at standard rates.
The U.S. Department of Health and Human Services set up HealthCare.gov to provide exchange services in states that are unwilling or unable to provide exchange services themselves.
This year, many big, for-profit issuers that lost money on exchange plans in 2015 have decided to pull out of the HealthCare.gov system in many counties in 2017.
Agents and brokers have complained that even some of the issuers that will keep their products on the HealthCare.gov shelves will not pay commissions in 2017, and that some issuers have failed to pay the commissions owed for 2016 sales or earlier sales.
California v. HealthCare.gov
Managers of the state-based ACA exchanges in some states have supported agents’ efforts to enforce compensation agreements, and even to impose minimum agent and broker exchange plan sales compensation standards.
In California, for example, Covered California has lobbied for national exchange agent compensation standards and set minimum standards for its own issuers.
HealthCare.gov managers have allowed issuers to pay commissions but have repeatedly said that they will not set payment standards, or help agents and brokers enforce existing compensation agreements.
HealthCare.gov does require issuers to offer the same compensation levels inside and outside the exchange system, and agents and brokers can ask HealthCare.gov for help with compensation-level differences, HealthCare.gov managers said during the conference call meeting.
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