Feds Are Pushing Navigators to Promote AHPs, Short-Term Health

“It’s time for the Navigator program to evolve,” Verma said.

CMS announced a year ago that it was tying grant funding for the 2018 enrollment period to a Navigator entity’s success at getting people to sign up for coverage.

This year, CMS officials said:

• It will provide at least $100,000 in Navigator grants for each of the 34 HealthCare.gov states.
• It will let a state have just one Navigator, and it will be open to letting a Navigator provide services in a state through digital and online outreach efforts, without having a physical presence in that state.
• It will base grant funding on a Navigator entity’s past success at getting people covered and meeting other performance goals.

CMS also says it wants the moderate-income uninsured people who have been “left behind,” and are not eligible for rich ACA premium tax credit subsidies, to be made aware of coverage options other than individual major medical coverage.

Navigators should “provide targeted assistance to serve underserved or vulnerable populations” that “may be unaware of the full range of the different  types of coverage options available to them, including coverage options in addition [exchange plans], such as association health plans and short-term, limited-duration insurance,” according to the Navigators program funding opportunity notice.

Navigators still cannot give consumer referrals to specific agents, brokers or insurers, but they’re supposed to help consumers find the HealthCare.gov agent finder tool.

Elsewhere, CMS officials made a point of noting that, although health insurance agents who are collecting commissions from health insurers for health insurance and stop-loss insurance cannot serve as Navigators, life insurance agents and other agents who get paid products to sell other types of insurance products can be Navigators.

CMS said it is welcoming Navigator applications from insurance agents and brokers as well as from community groups, unions, chambers of commerce, and trade groups.

HealthCare.gov managers are not the only ACA exchange managers with concerns about Navigator performance.

Managers of Covered California, a state-based exchange that has had a warm relationship with Navigator programs, said in a board meeting slidedeck posted in June that “Covered California remains committed to its Navigator program and the partnership with our grantees.”

But the Covered California managers also said that they “will actively engage our grantee partners in the development of a refreshed program that will build on existing expectations and provide robust incentives and rewards for continuing the good work of helping Californians get and keep health insurance coverage.”

Covered California said they have Navigator program data that “will assist in the development of new standards that may be used in the next grant period.”

3. Navigator Data

CMS recently reported that agents and brokers helped about 3.7 million people sign up for HealthCare.gov coverage for 2018, and that agents and brokers accounted for 42% of the 2018 enrollees.

CMS also indicated that the median agent and broker in the program handled about 50 2018 HealthCare.gov plan enrollees.

In the press release announcing the new Navigator grant program, CMS officials reported that Navigators handled “less than 1%” of the 8.7 million paid-up 2018 HealthCare.gov enrollees, or fewer than about 87,000 enrollees.

Calculations based on those figures suggest that the Navigator program cost HealthCare.gov an average of at least $400 per enrollment.

If the average HealthCare.gov Navigator enrollee had a monthly premium near the 2018 exchange plan average of $472 per month, that implies that the Navigators were getting the equivalent of a 7% agent commission.

Public figures on agent commissions in the individual major medical market are hard to find.

In 2013, when CMS was setting up the public exchange system, actuaries at Milliman estimated that insurers in California were paying commission rates of about 8% to 12% for new individual policy sales and 4% to 6% for renewals.

Vermont set its statutory 2018 exchange broker fee at $20 per month per enrollee, or $240 per year.

Agents have pointed out that, in many states, agent commissions are now under 2%, when commissions are paid at all.

Clarification: An earlier version of this article gave incomplete information about possible Navigator referrals and agent compensation levels. Navigators might give referrals for consumers interested in products such as short-term medical insurance to the HealthCare.gov finder tool. Current agent compensation levels in the individual major medical market appear to be much lower than they were in 2013 and, in some states, appear to be under 2% of the premiums, or non-existent.

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