Caution! There are known data miss-match issues between SAWS and Covered California CalHEERS software. When a consumer is released from Medi-Cal it is necessary to scrub the application and look for missing or inaccurate data and conditions. The missing data could prevent the individual or family from getting the subsidy. It could be as simple as the application no longer indicating that the consumer will file taxes. This is simply fixed by checking Yes, the consumer will file taxes. Both Covered California and Medi-Cal are working to resolve this issue.
So when an intelligent person calls me and wants my assistance with an insurance transaction that will benefit them greatly at the expense of all my other clients who faithfully make their premium payments every month, with no claims for years, I get an uneasy twinge in my gut. I am not a cheerleader for the health insurance companies. But at the same time I see no reason for me to facilitate an enrollment that will only add additional costs to the system when that client jumps out of the pool.
By assuming that Covered California is one big selling machine, the report also paints agents as little more than clerks at a supermarket. Agents do more than just ring up the consumer’s purchase and then watch them take their goods out the door. Agents, just like Covered California customer service representatives, are available all year to help with reporting changes to Covered California and assist with health plan problems. Some agents have complained that Covered California helps enroll the easy cases and the agents must work with individuals and families who have more complicated households, immigration issues, and income questions that require more time.
A review of 50 randomly selected terminated Covered California agents, as of May 12, 2017, showed 36 agent licenses were still authorized to transact insurance through the California exchange when reviewed through a DOI license search. 10 of the agents showed no authorization for Covered California. 3 agents were listed as Inactive and 1 had their licensed revoked. Of the fifty agents, 5 resided outside of California; 4 from Florida and 1 from Arizona.
I try to be pretty pragmatic when it comes to presidential elections. Regardless of the promises made by any candidate, we rarely see any real change in the U.S. with the election of a new president. However, Donald Trump ran on a platform to repeal and replace Obamacare. Since 90% of my income comes from enrollment generated by the Affordable Care Act, I am facing a drastic reduction of my income if Trump fulfills his promise.
For the first time in my life I can commiserate with people who are losing their livelihood because of a government action. Just as some workers have been displaced because the government outlawed a product, changed an environmental regulation, or enacted a trade deal that smothered their industry, I too am on the receiving end of government legislation that will decimate my income. If Obamacare is repealed and the subsidies that make health insurance affordable for millions of Americans ceases, I will lose 90% of my clients.
With the constant erosion of the commission structures to agents for enrolling consumers into health plans in California, many agents have expressed their desire to stop assisting individuals and families with enrollment into Covered California health insurance. There has been renewed talk of allowing agents to charge a consultation fee to make up for the dwindling commissions they earn from the health plans and insurance companies. However, if agents want to make a decent return for enrolling consumers into health plans they need to provide the service so many of them advertise. We need to move from order-takers to consumer advocates, and we need fair compensation for our services.
For the second time since the launch of Obamacare and Covered California, Anthem Blue Cross has cut the commissions they will pay agents for assisting consumers with enrollment into individual and family plans. Anthem Blue Cross now has one of the lowest commission structures for agents helping individuals and families apply for health insurance in California. This commission cut, coupled with rules limiting Covered California delegated agents from receiving commissions, has resulted in agents thinking twice before assisting consumers with Anthem Blue Cross health plans.
Cigna notified their appointed health insurance agents at the end of September that they will not pay any commissions in California for individual and family plans. In other words, or symbols, Cigna has given the middle finger to agents who assist consumers with enrollment into their health plans.
Consumers receive letters from Covered California stating that their estimated income doesn’t match with their most recent federal tax return. This has led many consumers to assume that Covered California can actually view a taxpayer’s federal return. Covered California can’t see a consumer’s federal tax return unless they send it to them to verify their income.