For the first time, I attempted to segregate my insurance revenue into the different categories of individual and family, vision and dental, Medicare, and small group. Individual and family enrollment commissions made up 85 percent of the revenue. Enrollments in vision and dental plans comprised 4 percent of my income. Medicare Supplements, Medicare Advantage, and Part D prescription drug plan enrollments total 8 percent of my income. Small group commissions came in at 3 percent.
Posts and commentary related to health insurance agents generally in California, commissions, carriers, service, Covered California.
If you consider certified agents are an extension of the Covered California customer service staff, the different agent compensation models are like paying a different hourly wage based on the health plan enrollment. The varying compensation amounts introduces a certain level of bias. If you are paid $15 an hour for enrollments in health plan X and only $8 per hour for enrollments in health plan Y, which health plan would you favor?
Covered California does not pay agents to assist consumers with enrollments into individual and family plans. The insurance plan or carrier compensates the agent. Agents are not paid anything for answering questions about Covered California. They are only paid a commission if the person enrolls into a health plan the agent represents and is appointed with.
Occasionally, I am asked whether I am an insurance agent or a broker. The underlying premise of the question is that the person does not want their insurance options limited to only those insurance companies the agent represents. The assumption is that a broker will not steer the client into an insurance policy that he or she receives the highest commission for. For the purposes of this discussion involving health insurance, there are no brokers, we are all agents. But not all agents are equal when it comes to the health plans they represent.
The family continued to wait, not paying any of the invoices they received because they figured that Covered California was working to resolve the issue. The health insurance plan was terminated by the health plan for lack of payment. If the consumer does not pay the all the premiums after 90 days, the consumer loses the right to make all the back-premium payments and reinstate the health plan. This is what happened to the family.
If the carriers feel threatened by the HCSM plans, they should lobby the legislature to ban those plans as well. Don’t use health insurance agents, under the guise of retribution from Covered California, to achieve the objective of limiting the enrollment in these plans. I completely get that if all the healthy people leave the pool, the carriers are going to have problems paying claims, and may exit the market altogether. We don’t want this to happen. But I’m just the agent. Don’t shoot me to protect your business model.
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.