With the deluge of changes in the functioning of the market and the new role of benefit marketplaces (aka private exchanges), most brokers feel they are stuck between a rock and a hard place. They know that they want to make the shift to exchanges, but are not yet certain how the move will benefit them. Moreover, brokers are concerned about differentiating themselves in an increasingly competitive private exchange market. Are you facing a similar challenge? We have an answer for you.

During our hCentive xChange conference, broker attendees participated in a roundtable discussion on how they collectively planned to achieve differentiation on the marketplace, and this is what we learned.

1)    Almost all brokers are harrowed by the benefit marketplace experience – For most brokers, moving to an exchange is disastrous. Almost all of their peers are suffering from early jitters of transition, but at the same time, they are very optimistic about the move to the platform. Most brokers felt that the change in marketplace is similar to the Medicare Part D ruckus, in the sense that it will get better with time.

2)    Individual Market will be more competitive compared to Group Market – Compared to the group market, the individual market will be more challenging and rewarding for brokers. More choice would mean more customers, and a larger chance for brokers to differentiate from their competition and tailor offerings that get them a bigger share of market.

3)    Benefit Marketplaces will be influenced by the performance of Public Exchanges – Over time, public exchanges will be laying the path for benefit marketplaces to tread upon. Currently, public exchanges have a higher share of enrollments, but benefit marketplaces are expected to take over by 2018. Public exchanges are the torchbearers for the market, and they are expected to ease the enrollment process for everyone and ensure that the risk pools are maintained in the private exchange market.



4)    Brokers will have a continuing role in shaping the private exchange market – Continuing in the footsteps of public exchanges, private exchanges will thrive and grab their share. In this environment, brokers will have a role to play, and contrary to the fear, will not fade away or become obsolete. In fact, brokers will have a bigger role to play, especially in educating their buyers and helping them make the perfect decision by sifting through available plans and finding ones that best meet their family’s needs. From a knowledge standpoint, a broker’s role in inimitable and irreplaceable.

 5)    Communication and Engagement will be key – As private exchanges prevail, brokers will have to rethink their strategy and phase it around communication and customer engagement. Follow ups and engagement tools will hold primary importance as customers will be expecting next-level interaction with their brokers.

6)    Adaption will be imperative to success in private exchange market – Almost all participating brokers agreed that adapting would be crucial if brokers do not want to be rendered useless in the private exchange market. Brokers don’t need to worry about cuts in their commission, but should rather focus on providing new lines of products and more choice to their customers. Communication and engagement will supplement their new offerings and changing stance toward customers.

The key to differentiation, as concluded in our breakout session, lies in mutating with the private exchange setup and supplementing broker offerings through value adding tools. In a final note, brokers have a great role to play in the future of private exchanges and to have a piece of that cake, evolution of their services and technology will be the answer.

As the third open enrollment period comes to a close, I’m reflecting back on the 2016 season and what did and did not work well for brokers.

One component of the enrollment process that really stood apart for me was the ability to seamlessly connect to HealthCare.gov (FFM) for quick and easy subsidy qualifications and enrollments.  Web Broker Entities refer to this process as the “Double Redirect” and is required by CMS for enrolling individuals online, regardless if they choose to self-service or leverage a broker’s assistance. As a licensed broker employed by hCentive that works on Federal and State Exchanges regularly, I can’t stress enough the importance of having online broker benefits tools that are CMS compliant. If your online enrollment platform provider is not CMS compliant, you’re putting your book of business at risk with sudden changes in the way clients enroll, or worse, not being able to conduct business.

Brokers are required to participate in annual training with CMS if they wish to sell on HeathCare.gov. During your training and/or certification process CMS clearly states there are two ways for a broker to enroll an individual:

  1. a broker may assist a client directly while they log into HealthCare.gov with their individual account, or
  2. by logging into HeathCare.gov as a broker, using a Web Broker Entity’s (WBE) direct enrollment process.
    [WBE Process]: When working with a client using a WBE, an agent or broker is securely redirected from the QHP issuer’s or Web Broker’s website to HealthCare.gov.  Once the broker is on HealthCare.gov they can complete the eligibility application with the consumer, using the agent or broker’s HealthCare.gov user ID. After the application is completed on HealthCare.gov, the agent returns to complete the enrollment on the Web Broker Entity’s site.

See: Resources for Agents and Brokers in the Health Insurance Marketplace

Reflecting on the above, is number one or number two consistent with what you, the broker, have been doing during the last few months of OEP? Or did you have to modify the way you were helping your clients due to a change in the way your current technology platform was working? If number one and/or number two above follows your process, then your technology partner has been conscious of their product design and eliminated any compliance risk for you and your clients.

For more information on working with a technology partner that offers brokers a CMS compliant platform to manage group and individual business, end-to-end management of quoting, enrollment, and administration and more.

These days everyone looks to technology, particularly apps, for consumer information and purchasing. Considering this and the exploding technology space for HR and benefits enrollment technology, I’m asking—can technology replace the role of the health insurance broker in assisting individuals and employer groups with their insurance purchasing decisions? In an Employee Benefits News article Ray Mara, SVP of Group Products at Guardian says “Employers rely on their benefit brokers not only to advise them on plan offerings and design, but increasingly on the service administration of those programs.” Keeping this in mind, let’s do a quick review on the value of using a broker to make insurance and benefit purchasing decisions:

  • Tailored Recommendations – Brokers work with their clients to make specific recommendations tailored to meet the client’s needs. For an individual client, they will discuss budget, goals, ACA requirements (potential subsidies available), and any specific family needs. For an employer client, they will review the organizational culture, approach to benefits, budget, compliance requirements, etc. Coupled with their industry knowledge they are well positioned to make a best-fit recommendation.
  • Market Intelligence – A broker understands their geographic market and the insurance carrier offerings. They can sit with their clients (or instruct them online) on comparing carriers, coverage details, and costs. They can easily point out the differences, identify problematic or beneficial areas, and help their clients analyze these differences, leading to stronger recommendations.
  • Relevancy – A broker with an existing client relationship has the ability to periodically review plan designs and cost to ensure their recommendations remain relevant to their clients’ situation.
  • Client Advocate – When a broker has relationships with their clients, they become a natural advocate for when issues may arise with insurance companies.
  • Enrollment Support – Additionally, for employer clients, the broker can take an active role in communicating benefits to employees and supporting the employees during Open Enrollment or throughout the year.

Considering the above, do we actually believe it’s possible for technology to replace the broker relationship? I think not.



Health insurance plans, and other insurance-related products are complex and it is ever increasingly important to make the right choices. Sure, decision support tools can be built into technology platforms to assist with filtering a multitude of plans for a consumer to choose. However, the personal relationship with a broker and their knowledge of carrier products and the marketplace cannot be replaced.

Ideally we’d like to see technology products that promote a partnership with brokers. In a technology-supported partnership, the broker and their clients benefit from the efficiencies of an online insurance marketplace and enrollment system. Imagine having the expertise of a seasoned insurance broker aligned with a single technology platform that allows brokers and their clients to view plans, make choices, enroll, and review on an on-going basis. Brokers are here to stay and the technology to support them, and their clients, will continue to grow as an important part of the consumer purchasing process.

Relevancy, value addition, and guidance – these are keywords being used in the evolving broker market at existing broker businesses. The role of brokers is changing due to the onset of a benefits marketplace approach in individual as well as employer business. At hCentive, we have been at the helm of the change rocking the broker market, and we have been participating in discussions with our broker clients, and this is what we have arrived at.

Die Out or Mutate, but Decide Soon

Out of our roundtable discussion at our past hCentive xChange Customer Conference, this was the prime sentiment echoing across our participating broker clients – brokers are in a dire need to evolve with the market or face extinction. With the new benefits marketplace exchange strategy making inroads, the traditional role of brokers is losing its charm and brokers need to evolve with the role to present better value to customers.
To compound the challenge, brokers need to adapt to the market’s speed, and that means adjusting with market change velocity. Die out or mutate, but take a quick decision to stay competitive in the market.

Right Engagement is Key to Retention

On the engagement front, brokers have made strong headway, but almost all our clients agreed that things could be improved here. Currently, the majority of a broker’s focus is on engagement, but only a few brokers are doing things right. The focus needs to move away from regular, low-value stuff, such as sending birthday cards, to high-value engagement, such as guiding customers with knowledge about their insurance health plans and shopping over marketplaces. Brokers need to realign their automated engagement touch points to present value to their audience.
At the same time, brokers need to strategize their automated touch points in a way that they are not the default authority whenever their clients have questions or issues. The strategy needs to be a combination of self-service and engagement during enrollment and renewal processes.



Leverage Knowledge and Exchange Familiarity

With exchanges and carriers, brokers have an advantage that is unprecedented – their knowledge base and exchange familiarity. From this standpoint, brokers will have a continued, renewed role to play, given that they sustain their knowledge and deliver it through all their engagement channels.
In this task, exchange familiarity will give them another advantage, and all of this will ultimately come together for their benefits marketplace strategy.

Rely on Multiple Product Lines for Continued Payout

With exchanges running the show, brokers cannot distinguish against their competition through offerings or price. The exchanges have taken over that role, and brokers need to up their game for continued payout from the market. Combining their knowledge vantage point with multiple product lines, brokers can arrive at a solid strategy that lets them establish new value in the evolved market without sacrificing too much of their commission. In short, if you want to continue being competitive in the market, you need to rely on multiple product channels and use your vantage point for lasting growth in the market.

About 6 million members enrolled in their benefits on a private health insurance exchange for the 2015 plan year, continuing an adoption trend with more than 100 percent annual growth since 2013. The mid-size employer segment of 100 to 2,500 employees is driving initial growth, which is projected to double again in 2016 to 12 million employees (source: Accenture analysis). The promise of choice, cost savings and customer experience dominate the trend-lines on private exchanges but innovation really holds the key to sustained adoption and growth.

Fidelity Investments® today announced the launch of Fidelity Health MarketplaceSM, which offers one-stop access to integrated health, wellness and financial benefits to small and midsized businesses and their employees (source: Fidelity press release). Fidelity Health Marketplace offers employers the ability to choose from an extensive network of national and regional medical, dental, vision, and life benefits in addition to tax-savings options and access to wellness tools and programs. The Marketplace uses hCentive’s WebInsure™ Benefits private exchange technology platform, which offers an integrated enrollment experience and pre-configured connections to a network of insurance carriers and a range of health and other ancillary benefits.

Integrating financial solutions with health and wellness offerings through a private exchange delivers a real “health & wealth” proposition. More importantly, it exemplifies continuous product innovation and expansion with both insurance and non-insurance products to meet the unique and specific needs of employers and employees. For example, hCentive recently added a socially responsible credit program that offers low-cost employee loans with 0% financing. Previously, employees would not have had access to such a program with payroll deductions, but our private exchange solution easily allows them to bundle the product if they need to manage high or sudden medical costs.

Innovation, coupled with digital footprint, branded storefront and sophisticated decision support tools for employees will bolster brokerages and financial services firms’ ability to differentiate from established competitors and emerging tech upstarts; provide employees with intuitive user interface and experience to shop, select and enroll in benefits; and, simplify and standardize onboarding of carriers and benefits products. That is what will really drive demand for private exchange solutions from employers in 2016 and beyond. Tell us what you think.

Experience the new Fidelity Health Marketplace at https://www.fidelityhealthmarketplace.com/.

Learn about hCentive’s WebInsure Benefits platform at https://www.hcentive.com/products/benefits/. Contact us to see what hCentive can do for you!

In the first part of this post, we discussed how public vs private enrollment is progressing, and private exchange enrollment is set to out-enroll public exchanges by a decent margin. In the scheme of things, small businesses are being left out. Small businesses lack the bulk power of large businesses, and that’s why traditional health plans have never truly focused on small businesses. With Obamacare SHOP exchanges, however, enrollment for small businesses is going to change. Before we begin with an analysis of SHOP exchange data, let’s take a look at how health insurance has traditionally worked in small and large employers. Read more

Other than attracting American population with better health insurance coverage at subsidized rates, Obamacare had another central goal – transforming the health insurance mechanism for small employers and their employees. The employer-provided health insurance segment is a primary means of coverage for a large number of the American population, and the state of insurance is not very heartening in this domain. With the Affordable Care Act acting as a catalyst for change, public and private exchanges are seeing a surge in enrollments as employers and employees reconsider their health coverage strategy. Let’s take a look at the outcome of the implementation of law across different systems of employee enrollment.

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Traditionally, young, healthy individuals have sacrificed the option of buying health insurance for having more liquidity and ability to pay rent and bills. Between competing for a highly coveted job and planning for the future, young individuals feel that they don’t have the time or resources to waste on health insurance. And why should they, when individuals under 26 rarely visit the doctor and generally enjoy a healthy lifestyle. Well, the answer to that is the high probability of a serious accident or an illness that could add up to thousands of dollars in bills and drug costs. So if you are one of those that wants to be insured in case of a mishap, here are the top things you need to know about getting health insurance in post Obamacare world.
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At outset of Obamacare, all eyes were on the troubled healthcare.gov launch that gripped the administration on October 1, 2013. While the Affordable Care Act was being lauded as the coveted reformer of the health insurance, it had its own demons to fight.

As time passed, exchange problems were weeded out and the system became better, with the administration launching offline enrollment measures to keep enrollments up. When the results started coming in, the administration had exceeded its expectations to finally deliver 8 million newly insured individuals on the federal exchange. The number of young adults, coveted for risk balancing in health insurance industry, signed up in decent numbers, with nearly 35 percent people signing up from this demographic. The administration thought most of the exchange problems were solved.
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As one of its primary aims, Obamacare has always centered on the theme that all Americans should have access to affordable healthcare. When the PPACA (Patient Protection and Affordable Care Act) was passed, subsidies and tax credits were put in place to allow uninsured to be able to afford health insurance plans. With enrollment numbers picking up, it is still clear that there are many uninsured who haven’t signed up.

There are several reasons impacting the number of enrollments and most of those reasons can be split into three broad categories – flawed health exchanges, convoluted processes and a lack of knowledge. Although the administration has spent a lot of money and time for educating Americans on the health insurance marketplaces, several groups have cited that they do not have all the information they require, especially people who think they qualify for some kind of health insurance subsidy but are not sure about their status. Fortunately, volunteer groups and exchange navigators are making a big push toward educating these groups. Let’s take a look at each of these endeavors in detail:

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