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Regulation and Compliance > State Regulation

3 New Weird Things About the Individual Major Medical Market

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Policymakers in Washington seem to have been using dice to set individual major medical policy for the past five years.

About the only thing certain about the individual market for 2019 is that calendar year 2019 will start Jan. 1 and run through Dec. 31.

(Related: Only 5% of Our Off-Season Buyers Can Afford Major Medical: Web Broker)

For now, until the dice roll again, it looks as if the open enrollment period for 2019 should start Nov. 1 and end Dec. 15. — the program the U.S. Department of Health and Human Services set up to provide Affordable Care Act exchange services in states where locally based ACA exchange programs are unable or unwilling to provide the services — had registered 10,885 people to serve as agents or brokers for the 2019 open enrollment period as of Monday. That’s up 28% from the number of producers had registered a year earlier.

Here are three other strange new developments in the individual market.

1. Academic researchers talked to insurance agents and brokers.

Since policymakers began thinking about the proposals that created the Affordable Care Act, drafting the ACA, and implementing they ACA, they have surveyed health care providers, patients, employers, insurers, and nonprofit ACA exchange system helpers.

They have probably talked to their friends, relatives and baristas.

They have not spent much time talking  to agents and brokers.

Kevin Lucia and colleagues affiliated with the Urban Institute recently stunned observers by talking to brokers.

They published a report, distributed by the Robert Wood Johnson Foundation, based on discussions with a representative from a national web broker, and with 22 brick-and-mortar brokers. The brick-and-mortar brokers were based in six markets suffering a high level of individual major medical market disruption: Georgia, Iowa, New Hampshire, Mississippi, Texas and Utah.

The average individual major medical gold plan premium in those markets increased somewhere from 24% to 52% between 2017 and 2018 in each of those states. In four of those states, no enrollee had a choice of three or more insurers.

A copy of the full report is available here.

Here is some of what the researchers found:

• Many brokers have (surprise!) left the individual major medical market because the number of issuers in their states have dwindled, and compensation levels have fallen.

• A Mississippi broker has seen agent comp fall to $8 per member per month, from $30.

• A New Hampshire broker said commission levels are 70% lower now than they were in 2008.

• Utah now requires insurers to offer the same commission levels for special enrollment period enrollments that they offer for open enrollment period enrollments.

• A Georgia broker said that, in that broker’s area, thanks to the effects of the ACA individual mandate and ACA coverage expansion programs, “The psychology now is to have health insurance.”

2. The Centers for Medicare and Medicaid Services scraped up $8.6 million to support state insurance individual market regulation efforts.

Policymakers in Washington have not been eager to increasing funding for health insurance programs, but CMS came up with $8.6 million in grant money to help state insurance departments do things like analyze their markets, or to apply for CMS waivers from some of the usual ACA individual market rules.

CMS announced Monday that it was awarding the state flexibility grant awards to 30 states.

CMS came up with the grant money by using cash left over in an ACA state rate review grant fund.

A list of the states that received grants is available here.

3. The state with the biggest off-exchange individual major medical market is California.

Covered California is a state-based exchange that has a reputation for transparency, aggressive marketing, and reaching out to agents and brokers, but it has captured a lower share of its state’s individual major medical market than has captured in Florida, according to data from Mark Farrah Associates.

Mark Farrah Associates put state-by-state off-exchange enrollment figures in a recent analysis of the individual market.

CMS, an arm of the U.S. Department of Health and Human Services, set up to provide ACA public exchange services in states in which locally based exchange programs are unable or unwilling to provide all exchange services.

Florida’s section of has more enrollees than any other state’s exchange program.

The Florida exchange has helped 1.7 million people get covered this year, and its enrollees account for 87% of Florida individual major medical insureds.

An ACA public exchange covers about 75% of a jurisdiction’s individual major medical insureds in all 50 states and the District of Columbia.

California ranks second in terms of the sheer number of public exchange plan enrollees: Covered California has helped 1.5 million people get covered.

But Covered California has only a 67% share of its state’s individual major medical market.

California still has about 765,000 off-exchange individual major medical enrollees, and it has more off-exchange enrollees than any other state.

Texas ranks second, with 491,000 off-exchange individual major medical  enrollees.

Florida has only about 263,000 off-exchange individual major medical enrollees.

— Read 5 Things a Short-Term Medical Issuer Executive Sees Out There Nowon ThinkAdvisor.

— Connect with ThinkAdvisor Life/Health on Facebook and Twitter.


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© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.