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

Rules on health insurance exchanges are dynamic and always evolving. Some agencies fear these changes may displace us, as Travelocity has displaced many travel agencies. Others argue that our expertise and advice will be even more important, as health insurance is a much more complex purchase than a plane ticket, and consumers are likely to be confused by these new channels.

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

Health Insurance Change: A Definition

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

Some states, including Colorado, where Alliance Insurance Group is located, are taking the initiative to establish their own exchanges, which are permitted by federal law but subject to certain guidelines. States that choose not to create their own stock exchanges until 2014 will need to use the federal stock market.

States that construct their own exchanges typically speak of a desire to control their own destinies and customize their exchanges to the needs of the local population. States that reject proposals for change often express their reluctance to support any aspect of the federal reform bill they hope to be overturned by the Supreme Court.

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

  • Buy and compare health plans that should include certain standardized benefits.
  • Determine eligibility for a premium deduction in the form of a tax credit.
  • Call or sit down with someone who can help explain the various benefits and plan the features.
  • Sign up for a plan.
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Below are some of the most relevant aspects of health insurance exchanges for independent insurance agents.

Consumer Access to Agents

The National Association of Health Insurers (NAHU) is lobbying to include the option to contact an agent in exchanges’ online systems. It can be configured similarly to the national Web-based home selling portal, which presents listing information in a standardized format but also connects potential home buyers to a state-licensed real estate agent.

Importance of Certification

NAHU also believes that all agents participating in the exchanges must pass an exam that considers options eligible for private coverage, public assistance, and subsidies to ensure familiarity with all coverage options available to consumers. This information is important to agents as well as individuals filling the new role of “healthcare traveller”. Navigators will receive federal funding to help educate the public, distribute information on enrollment and premium loans, and provide enrollment assistance. NAHU believes seafarers are copying the role of licensed agents and questions the wisdom of spending federal money on these positions. However, if navigators are used, they must be subject to the same strict licensing and continuing education requirements as agents.

Marketing and Commission Limits

There is talk of restricting the marketing activities and commissions of agents related to their activities in the stock exchanges, which NAHU strongly opposes. The rationale for this is that Medicare Advantage, the precedent for such restrictions, does not apply here at all. For the under-65 and small business health insurance markets, potential clients often require agents to provide additional typical information about living, dentistry, disability, and other elements of the employee benefits package in a single meeting.

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As for commissions, we believe they should be determined by private health insurers as they are today. However, health plans have already begun to cut commissions in response to other aspects of health care, such as administrative and health reform. medical loss rate requirements. The best isolation from commission deductions is to join forces with a General Managing Agent (MGA) that can consolidate the sales activities of many agents and guarantees insurers high throughput.

Will the Changes Really Help?

In this regard, it can be said that “the jury is out”.

Will stock markets lower premiums? The answer largely depends on how risk pools are structured. Some argue that pools are separate versus separate pools for individuals. Small businesses are fairest as the premiums more accurately reflect the risks of these two very different markets. Others say merging pools will allow for a broader spread of risk and facilitate lower prices for everyone.

Will the changes improve the overall health of the population? The hope is that, among other things, costly emergency room visits will decrease when a larger percentage of citizens are covered. Others counter that those with low-benefit/high-deductible plans are reluctant to seek acute preventive care or even care until absolutely necessary. Will the changes improve the healthcare purchasing experience? Probably. In theory, ranking the benefits “from apples to apples” should make shopping easier – unless it results in a series of indistinguishable, similar schemes that blur together and further confuse the consumer.

Like many facets of healthcare reform, we as agents may need to embrace change and adapt to the changing landscape as best we can. There is power in numbers – through your local professional organization and a good MGA helping you with your insurance agent business plan, you can manage these changes as gracefully and knowledgeablely as possible.

About Lily Hammond

I have been working as an insurance consultant in my own insurance agency since 1998. Because I've been doing this for so long, I know every detail and I'm here to help you. You can find my e-mail address and work phone on the contact page.

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