What are the common roles & challenges for brokers recruited as Navigators/Assisters?
As a navigator or assister, a broker should be able to:
• Establish exchange eligibility of the individual, employer, etc.
• Provide information about different Qualified Health Plans (QHPs)
• Offer information about premium tax credit eligibility
• Offer direct enrollment options
• Execute cost-sharing calculations
• Identify people or businesses eligible for premium assistance
• Communicate across linguistic and cultural mix that an exchange caters
• Offer clarity regarding cost structure of different metal plans—bronze, silver, gold and platinum
• Advise consumers about primary, secondary insurance coverage options or ancillary health plans to create a comprehensive coverage portfolio
• Help the state exchange manage its risk pool
Brokers willing to work for state (We offer Broker Solutions for Texas and some other states ) or federal health insurance exchanges should fulfill eligibility conditions that can include a training course, examinations and certification. Brokers should be ready to comply with stringent federal or state regulations, particularly those related to confidentiality, privacy and accountability. Personnel employed by the exchanges are most likely to be under strict supervision. This has been emphasized in the ACA rulings to prevent a navigator or assister from being biased. A stringent, exam-based certification process to ensure proficiency of navigators and assisters is most likely to prevail. Federal and state authorities could pool resources to create an effective competency or certification program to ensure workers are technically and ethically competent and up-to-date with recent trends in the healthcare industry.
Eliminating common misconceptions about brokers working for health insurance exchanges:
1. Brokers will not be employed as typical Medicare Health Insurance Advisors!
Some people have opined that the role of brokers on the exchanges will be similar to the health insurance advisors selling Medicare Advantage products. However, this comparison seems rather misdirected. Firstly, the Medicare Advantage plan serves a rather different and restricted demographic. These are people in the 65+ age group who need information about similarly-structured health plans. Here, cross-selling is prohibited. However, at the exchange, navigators and assisters will serve every kind of demographic a state offers. They would be allowed to discuss numerous health plan options to ensure that consumers make an informed decision.
2. Brokers will not be compensated like Medicare Advantage Plan agents!
Some voices have emerged, asking that assisters be paid via a regulated commission method. This is the standard practice followed for sale of Medicare Advantage Plans. However, the exchange scenario is a bit different from the federal-funded Medicare Advantage Plans. The federal government was keen on regulating how commissions are paid in that market. The idea was to create almost fixed incentives or commissions for agents where the emphasis was not on adding volumes to the coverage. However, private and public health insurance plans sold at the health insurance exchanges will be promoted by assisters with the purpose of enrolling more people. Thus, a cap on the assisters’ commissions is not likely to prevail.
Web Brokers & the Exchanges
States have taken different approaches toward allowing web brokers in the exchange marketplace. Some states have decided not to allow web brokers to function in the SHOP Exchange while some have decided not to involve web brokers during the first phase of enrollment beginning January 1, 2013.
If allowed, web or online health insurance brokers will function with some minor changes to their practice. First, a secured connection between the web broker’s and exchange website would be mandatory to ensure that enrollment information is communicated safely. Here, a consumer will begin his health plan shopping at the broker’s portal. The broker’s portal will direct the consumer to the exchange website for performing critical functions such as eligibility determination or cost-sharing calculations. The insurer will be notified about the web broker facilitating the sale. For this system to work, web brokers will need to comply with many exchange regulations, particularly those related to privacy and security requirements.
More about Brokers Providing Consumer Assistance Roles in the Exchanges
The ACA has recommended that states should consider more forms of consumer guidance, like recruiting Enrollment Counselors. Health insurance exchanges are also likely to invest in call centers and enrollment offices established in visible public places. The idea is to ease accessibility and maximize outreach capabilities of the exchange. State-run call centers will perform basic consumer assistance. Considering their familiarity with the health insurance market, brokers might be recruited for such exchange-linked roles too.