As the date for the ACA open enrollment approached, most health insurance agents were nervous about what to expect and what role they might play in helping clients enroll in the new health plans. This anxiety was enhanced by the cold shoulder given them by Covered California and the health insurance companies in terms of training and information. At the end of open enrollment, many agents felt as if they had been abandoned by the carriers and Covered California while trying to help their clients. This has left some agents wondering if now is the time to organize into a guild and work for better training, enrollment tools and fair compensation for the assistance they provide to their clients.
Health agents boost ACA enrollment
By Covered California’s estimates agents assisted 39% of the 1.3 million households that ultimately enrolled into health plans through the state exchange. Unknown is the assistance agents gave freely by answering questions for Californians who did not delegate them as their agent and enrollment of individuals and families into Medi-Cal. Agents were also supposed to be the primary contact point for the 1,156 small groups that enrolled in California’s Small Business Health Options Program (SHOP).
Heath agents overcame Covered California road blocks
Agents contributed a larger enrollment percentage than the designed Covered California program had anticipated as the emphasis was always to drive enrollment through the website, call center and Certified Enrollment Counselors. For all the grant money spent on designing the Certified Enrollment Counselor (CEC) program, CEC enrollment was only 9% of the total. Late in the open enrollment game, Covered California started courting agents for enrollment assistance even though the agent enrollment web portal was riddled with problems and the SHOP website just died.
Carriers unprepared for agent enrollments
The frustrations and road blocks for agents to assist clients didn’t stop with Covered California. The carriers themselves were ill-prepared to support agents as well. From dubious provider search features, missing household enrollment information, clogged phone lines, billing nightmares and, finally, stalled or completely missing commission payments, the health insurance companies and health plans virtually ignored the burden agents were carrying for their clients during open enrollment.
Health agents advocate for clients
Health agents are unique in that they are the only people that can advocate on behalf of an individual, family or small group before the carrier. Covered California Certified and licensed agents are the face of customer service when a client has an issue with the state exchange or the health plan. Health agents reduce the customer service expenses for both Covered California and the health plans as we solve problems and answer questions so the client doesn’t have to inquire with the exchange or the carrier.
Is it time for health agents to organize?
Health agents have more than proven their value to the carriers, Covered California and their clients. It’s now time that agents be recognized for their contribution, not with an insincere pat on the back, but with concrete reforms to the overall system. It may also be time for agents to form a guild to advocate for changes to the Covered California enrollment system and for better support and compensation from the carriers.
Reforms needed by health agents
Input to training and certification
Agents should have input into the Covered California training for certification. Covered California staff design a horribly weak training presentation and test that didn’t come close to preparing agents to assist clients. As one of the front lines of enrollment, agents need real training on ACA regulations on such issues as what constitutes income, immigration and citizenship status, making changes to household income, size and plans and how Medi-Cal works with dependents and families.
Compensation for Medi-Cal enrollment
Agents should be paid for enrollments in Medi-Cal. Just as much work can go into creating an application for a family that is deemed Medi-Cal eligible as one where the family receives the Advance Premium Tax Credit. There will be, and have been, families that move between ACA health plans and Medi-Cal all with the assistance of an agent. An agent’s time is just as valuable as a call center staffer making an hourly wage that enrolls a family or individual into Medi-Cal.
Uniform health plan appointments
Health plan appointments must be uniform. Some health plans are requiring additional training above and beyond the Covered California certification just to be appointed and receive commissions. Some health plans require an agent register through a general agent and some have stipulated that no commissions will be paid even with appointment and the enrollment of clients in the health plan. If an agent is certified through Covered California they should be appointed with the regular paperwork and there should be no non-commissionable enrollments.
Timely commission payments
It is inexcusable that the carriers don’t pay commissions in a timely fashion. It is not the fault of the agents if the carrier’s off-exchange enrollment system is flawed or that they have received incomplete or flawed information from Covered California. The carriers must resolve these issues and provide a timely and accurate reconciliation of all commissions due the agent. As of April 23, 2014, some agents have yet to see any commission payments for enrollments processed in 2013.
Commissions commensurate with customer service
Commissions on IFP need to increase. With the implementation of the ACA in 2010, more power has been amassed by the carriers in dictating commissions. The commission reductions of over 50% on individual and family plans have been erroneously attributed to the ACA provision of meeting the Medical Loss Ratios. While the carriers cut the agent commissions, there was no word that they cut the wages of their customer service representatives, marketing budgets or the bonuses paid to their CEO’s to meet the MLR. In short, the MLR is a red herring for an opportunity for the carriers to starve agents out of competing against their own direct marketing efforts.
Health Underwriters?
The one association of brokers and agents, California Association of Health Underwriters (CAHU), is seen more as a mouth piece for the carriers than a true advocate for agents and their clients. Their very name, Health Underwriters, harkens to the era when health insurance could be denied on the basis of a pre-existing condition and the carriers wanted the agents to perform “field underwriting” to steer potential claim generators away from applying. Members of CAHU and their parent organization the National Association of Health Underwriters have openly called for the repeal of the Affordable Care Act and the taxes that help support the Advance Premium Tax Credits.
The vision of an agent’s guild
The vision of an agent’s guild would be one that fights for the value that agents have brought to the ACA by assisting clients with enrollment and subsequent problems. The guild would advocate for better training, support, equal access to appointment with all health plans and commission structures from both the carriers and Covered California. Health agents have proven their value with committed client support and the subsequent loss of income from late or denied commissions because of issues between the carriers and Covered California. It’s time for health agents to coalesce into a group and advocate for the survival of the agent community by demanding reforms from the health plans and Covered California.
If you are interested in the idea of creating an agent’s guild, send me email.
See also: Draft proposal for California Health Agents’ and Brokers’ Guild