What We Do (and Don’t) Know About Health Insurance Exchanges

The rules around health insurance exchanges are dynamic and evolving all the time. Some agents fear these exchanges could displace us-in the way Travelocity displaced many travel agents. Others argue that because health insurance is a far more complicated purchase than an airline ticket, and because consumers are likely to be confused by these new channels, our expertise and advice will be even more crucial.

Hopefully, the role of agents will become clearer as time goes on. In the meantime, here’s an overview about what we do-and don’t-know about health insurance exchanges.

Health Insurance Exchange: A Definition

A health insurance exchange is an online marketplace where individuals and small businesses can shop for, compare and purchase health insurance. Think of it as an Expedia or Travelocity for health insurance. No one is required to use an exchange; it is an additional channel being added to the marketplace.

Some states, including Colorado, where Alliance Insurance Group is based, are taking the initiative to build their own exchanges, which are permitted by federal law but subject to certain guidelines. States that choose not to create their own exchanges by 2014 will be required to use the federal exchange.

States building their own exchanges typically cite the desire to control their own destiny and customize their exchange to the needs of the local population. States that have rejected exchange proposals often mention their reluctance to support any aspect of the federal reform bill, which they hope will be repealed by the Supreme Court.

In general, insurance exchanges allow consumers and small businesses to:

  • Shop for and compare health plans, which must include certain standardized benefits.
  • Determine eligibility for premium relief in the form of tax credits.
  • Call or sit down with someone who can help explain various benefits and plan features.
  • Enroll in a plan.

Following are some of the most relevant aspects of the health insurance exchanges for independent insurance agents.

Consumer Access to Agents

The National Association of Health Underwriters (NAHU) is lobbying for the inclusion of an agent-contact option within the exchanges’ online systems. This could be structured similarly to the national Web-based portal for home sales, which presents listing information in a standardized format, but also connects potential homebuyers with a state-licensed realtor.

Importance of Certification

NAHU also believes all agents participating in the exchanges should be required to pass an annual exam that addresses private coverage, public assistance and subsidy-eligible options to ensure familiarity with all coverage choices available to consumers. This knowledge is important for agents as well as individuals filling the new role of “healthcare navigator.” Navigators will receive federal funding to help educate the public, distribute information about enrollment and premium credits, and provide enrollment assistance. NAHU believes navigators duplicate the role of licensed agents and questions the wisdom of spending federal money on these positions. But if navigators are used, they should be subject to the same rigorous licensing and continuing education requirements as agents.

Marketing and Commission Limits

There has been talk of restricting agents’ marketing activities and commissions related to their activity within the exchanges, which NAHU strongly opposes. The rationale is that the precedent for such constraints-Medicare Advantage-does not apply here at all. For the under-65 and small-business health insurance markets, prospective clients often want agents to provide additional information about life, dental, disability and other elements of the typical employee benefits package, within a single meeting.

With regard to commissions, we believe these should be determined by private health insurers, as they are today. That said, health plans have already begun cutting commissions in response to other aspects of healthcare reform, such as administrative vs. medical-loss-ratio requirements. The best insulation from commission cuts is to join forces with a Managing General Agency (MGA) that can consolidate the sales activity of many agents, guaranteeing insurers a high volume of business.

Will Exchanges Really Help?

It’s safe to say that “the jury is out” on this matter.

Will exchanges lower premiums? The answer depends largely on how the risk pools are structured. Some argue that separate pools for individuals vs. small businesses are fairest, as premiums more accurately reflect the risks of these two very different markets. Others say combining the pools would allow risk to be spread across a larger base, facilitating lower prices for all.

Will the exchanges improve the overall health of the population? The hope is that, among other things, costly emergency room visits will decline once a larger percentage of citizens are covered. Others counter that those with low-benefit/high-deductible plans are also reluctant to seek preventive care or even acute care until absolutely necessary. Will exchanges improve the healthcare purchasing experience? Possibly. In theory, lining up benefits “apples to apples” should make shopping easier-as long as it doesn’t result in slew of indistinguishable, look-alike plans that blur together and further confuse the consumer.

Like so many facets of healthcare reform, we as agents may have to embrace change and adapt as best we can to the changing landscape. There’s strength in numbers – through your local professional organization and a good MGA who has helped you with your insurance agency business plan, you can navigate these changes as gracefully and knowledgeably as possible.