Insurance manager Cindy Holtzman was a little surprised by the announcement from Bright HealthCare, one of the insurers offering Affordable Care Act coverage in her area.
The organization’s February statement said its health plans had seen “significant growth” – going to the “one million -member mark” last year – and that trend was firmly entrenched in relationships. good with brokers. But the memo continued, the developer wants to “slow growth now that private sign -ups” and thus stop paying commissions to brokers to sign up new people to cover. starting April 1st.
“Why buy something I won’t be paid for?” Holtzman in Georgia recalled the meditation.
Bright Health isn’t just a commission -cutting business. Other insurers, including Oscar, Molina Healthcare, and some Blue Cross Blue Shield providers, have done the same now – such as the Biden administration’s release of a unique brand name option. The new ACA refers to the enrollment of low -income Americans into ACA coverage outside of the normal annual opening period. The new enrollment program is available in mid -March for coverage to begin in early April.
The insurance company, however, opposes the plan, saying that those who sign up outside the last year’s enrollment window will be seriously ill, leaving no. the cost of insurance, and the number of tenants.
“We have serious concerns that it will create instability in the private market and result in higher fees for global subscribers,” AHIP wrote in a July letter to federal agencies.
Consumers, insurers say, can wait until they are sick to sign up or change plans to one with better benefits. The Centers for Medicare & Medicaid Services estimates that a low -cost enrollment program can increase costs by 0.5% to 2% each year depending on the number of patients enrolled.
Special enrollment periods are allowed under the ACA when prompted by certain life events. Others sign up during the annual registration period, usually from November to January. That limit is designed to reduce the need for people to wait until they are sick to buy insurance, which in turn will increase the cost of living for each person.
Last year, the Biden administration added a six -month covid -related subscription campaign, which recorded 2.8 million signatures.
However, “there is little data about patient attendance” in the special enrollment periods that have taken place since the ACA began, said Katie Keith, a researcher at the Center on Health Insurance Reforms at Georgetown University, with the addition of some of the certification. The industry -sponsored rules regarding the differences in pre -special enrollment are so complex that they can be more detrimental to health than for patients. Brokers understand that low -income buyers look to brokers when considering insurance.
“They’re the people who always need help,” said Marcy Buckner, senior president for public affairs at the National Association of Health Underwriters, a business and lobbying organization. “Agents and brokers want to help customers, but they have to open their doors. If they don’t get commissions, they can’t help those customers.
The move by some insurers to cut commissions on April 1 has caught the attention not only of brokers but also of federal regulators.
“We are concerned about the impact on customers, the more customers are in their position to lead them to sign up in the middle of the year, and they are actively researching this. , ”said Ellen Montz, director of the Center for Consumer Information and Insurance Oversight at CMS. To say.
The Biden program allows people living below 150% of the federal poverty level – about $ 19,320 for one person or $ 32,940 for a family of three – to enroll at any time of the year. . Other special enrollment programs, such as those who have lost insurance related to employment, marriage or divorce, or want to include a baby in their plans, are time -limited. Among those currently unregistered, 1.3 million could vote for the new low -income enrollment option.
There may be a lot of people who need help registering quickly for some other reason, policy experts say. Some believe that millions of people could lose Medicaid coverage when the health crisis is over because states are not bound by an agreement they made with the federal government not to abandon. to registrants during illness.
While most of those health care providers enroll on their own through federal or state markets, or seek help from federal financial aid providers, experts say they may seek some. to private brokers, they don’t want to take on clients if they don’t. pay for their time.
“If employers don’t pay commissions for the special enrollment period, it’s reducing enrollment,” said Sarah Lueck, vice president for health policy at the Center on Budget and Policy Priorities, a box left -wing thinking in Washington, DC
Deputies and employers also argue that commissions could change mid -last year under federal or state rules that prevent discrimination.
They cite the CMS guideline released in 2016, when some developers changed commission houses, telling the industry to oppose practices that had the effect of “lowering enrollment. Access to health insurance for people with serious health needs. “
Oscar and Molina did not comment on this story. In a written statement, Bright HealthCare said the company is trying to “ensure continued maintenance of reasonable costs,” and “is working with its customers to achieve to the [special enrollment period] The commissions changed as part of the result.
The Biden administration’s new policy for low -income enrollment applies directly to 30 states that use the federal health care system; The rest are running their own stores to choose whether to give. Those who are eligible for Medicaid or those who have a job -related income that meets ACA requirements are excluded according to the cost.
While the new special enrollment period is expected, it will be related to the approval of increased funds received through the American Rescue Plan Act to help people purchase cover, which will expire by the end of 2022. unless extended by Congress.
Suppliers have also expressed concerns about more expensive customers signing up for special occasions, with some claiming higher prices at the end of the year. passed on new registration.
Some of those cutting commissions, like Molina, have consistently reported earnings in the past year.
But not all. Oscar, for example, posted a 49% jump in membership in 2021, but a loss of $ 571 million. Bright Health Group, the parent company of Bright HealthCare, also reported growth in membership last year, but at a loss of more than $ 1 billion.
Brokers said federal numbers are seen with them nearly half of all signups during special sign -ups assisted by brokers.
Insurers don’t have to lend to brokers on the one hand for their growth and then cut their fees, said Ronnell Nolan, president and CEO of Health Agents for America, a technology company and advertising for brokers.
“They can point out how much money is being lost. I always say, ‘Let’s look at how much money the boss makes and you choose, it’s not zero,” he said. Nolan. “If they’re not doing well with their money, that’s not my job. We’re doing our jobs.”
The commissions are paid by the insurers, so customers pay less to use the insurer than those who don’t. However, commissions are included in the overall costs, costs can increase on the board, and some policymakers question whether the commissions lead delegates to demand certain improvements on the board. something else.
Unlike brokers, government investors do not receive a commission, and they cannot direct a specific plan for clients.
“We’re helping them filter through programs, which can be intimidating,” said Jodi Ray, director of the nonprofit Florida Covering Kids & Families, one of 60 Navigator programs operating in 30 states.
Navigator programs were boosted this year when the Biden administration raised significantly more revenue than the levels paid during the Trump administration.
So Ray isn’t worried about not having enough staff to help people with low enrollment again or the expected wave of former Medicaid patients losing their Medicaid eligibility when it expires. and in the time of trouble.
But he worries “because the state wants to show people where they can get that free help.”
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