Part of the Pennie.com homepage that shows a log-in link for agents and brokers right at the top of the page. A screenshot of the upper left-hand portion of Pennie.com’s homepage. (Credit: Pennie.com)

The open enrollment period for 2021 individual and family major medical coverage starts Nov. 1 — but major medical coverage may be having a hard time competing with Halloween, politics and COVID-19 for consumers’ attention.

One rough interest indicator is the Google Trends search activity tracker.

(Related: Agents Work to Hold 2021 Individual Major Medical Market Together)

On Oct. 27, for example, people in the United States searched for “COVID-19″ almost two times more often than they searched for “health insurance,” and almost 10 times more often than they searched for “Obamacare.”

Insurers may be relying on agents and brokers more than in recent years to persuade consumers to get and stay covered.

The Words

Insurers, regulators and Affordable Care Act (ACA) public exchange plan managers created the open enrollment period system. This puts limits on when people can buy ordinary individual and family major medical coverage without showing they have what regulators classify as a good reason to be shopping for coverage, to compensate from some of the effects of the ACA.

The ACA took away most of the defenses health insurers once used to protect themselves from high claim costs.

Supporters of the open enrollment period system says it pushes younger, healthier people to pay for health coverage even when they feel fine, by raising the possibility that, at some times of the year, they might not be able to get health coverage if they, say, suddenly break a leg.

2021 Open Enrollment Period Start and End Dates

The ACA exchange system gives consumers a way to use federal premium tax credit subsidies to buy health coverage through web-based insurance supermarkets.

The U.S. Department of Health and Human Services will provide ACA exchange program services for residents of 36 states in 2021 through the HealthCare.gov website.

The individual major medical coverage open enrollment period will run from Nov. 1 through Dec. 15 in the HealthCare.gov states.

The District of Columbia and 14 states will run their own ACA exchange programs. Those states can do what they want about their open enrollment period schedules. Connecticut, Idaho, Maryland and Vermont appear to be using the HealthCare.gov timeline.

In the other 11 jurisdictions with locally run exchange programs, the earliest scheduled open enrollment period end date is Dec. 22, in Minnesota. The latest is Jan. 31, in California, New Jersey, New York and the District of Columbia.

Exchange Program University

The Georgetown University Health Policy Institute Center on Health Insurance Reforms has developed a free guide to the individual health insurance market and the ACA exchange program. The center created the guide for Navigators, or nonprofit ACA exchange ombudsmen, but agents and brokers can use it, too.

Agents Are the New Drinking Water

Here are five trends to watch in the individual and family major medical market.

1. Agent-broker love

In the past, before the ACA public exchange system came along, several companies tried to sell health insurance directly to consumers through the web.

Many of those companies ended up focusing mainly on serving brokers, making a majority of their sales through agents in call centers, or combining call center sales and distribution through brokers with some retail, web-only sales.

Managers of Covered California, Connect for Health Colorado and HealthCare.gov have indicated that about half of their enrollees come in through agents and brokers.

Agents and brokers have complained since 2014 about health insurers cutting or eliminating commissions, but many of the exchange program managers seem to be working harder than ever to appeal to agents and brokers.

Managers of HealthCare.gov, for example, are highlighting agent and broker registration numbers. They reported in a news release Monday that, as of Monday, they had registered 37,000 returning producers for the 2021 open enrollment period and attracted 5,300 new producers.

Kevin Patterson, the chief executive officer of Connect for Health Colorado, Colorado’s ACA exchange, wrote in a promotional email that the exchange staff is finalizing marketing and advertising plans to get the word out.

“We also know our brokers and assisters are starting to get appointments on the books to help enroll customers, so we redesigned and just launched our open enrollment electronic marketing materials to better support virtual appointments,” Patterson wrote in the email.

In New Hampshire, a state that uses HealthCare.gov, Insurance Commissioner Chris Nicolopoulos put out a press release encouraging state residents to talk to agents about how to get covered.

Pennsylvania has started its own, locally run ACA exchange, Pennie.com. On the web version of the site, an agent log-in link shows up in the upper left corner of the homepage.

On the mobile version, there’s a “Broker & Assister Resources” link at the bottom of the Connect page.

2. Exchange-related businesses

Some commercial ACA exchange support companies have hung on and are still helping exchanges and exchange agents operate.

GetInsured, for example, has outlasted several competitors established itself as an ACA exchange runner.

The company helped Pennsylvania set up Pennie.com. The company is also providing the technology behind the locally run exchange programs in California, Idaho, Minnesota, Nevada, New Jersey and Washington state.

HealthSherpa and AgentExpress continue to offer to help agents process exchange plan business without dealing directly with HealthCare.gov.

3. Ancillary benefits

An ACA exchange must sell major medical insurance. It can sell other things, too. Connect for Health Colorado, for example, has logos for dental and vision plan providers on its homepage. Managers of Nevada Health Link recently announced the addition of vision plans from VSP.

4. Ads

At least one ACA exchange, Your Health Idaho, is selling advertising space on its website. Many of the sponsors are local health insurance agents and brokers.

5. Individual coverage health reimbursement arrangements (ICHRAs)

The administration of President Donald Trump has used the new ICHRA program to bless the practice of employers providing cash that the employees can use to buy their own individual health coverage, either through the ACA exchange system or outside of the exchange system.

The ICHRA program came to life in January, shortly before the COVID-19 pandemic rolled in. The virus ate up much of the health policy watcher attention that might otherwise have focused on ICHRAs.

Take Command Health, one of the players in the ICHRA market, says in a new report that the number of employers using its ICHRA services has been growing steadily.

The company has not provided an overall employer count, but it says it has shifted 46 employers from the qualified small employer health reimbursement arrangement (QSEHRA) program to the ICHRA program, to help those employers take advantage of the higher ICHRA program benefits limits.

The employers using Take Command Health ICHRA services have ranged in size from one eligible employee to 151 eligible employees.

The average 2020 Take Command Health client ICHRA reimbursement rates have been about $750 per month for singles, $847 per month for couples and $932 per month for families.

The average employee participation rate for ICHRA programs has been 58%, which is comparable to the average participation rate for other types of employer-sponsored health coverage, according to Take Command Health.

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