I'll Have a Health Plan with that Burrito, Please

[tracy5963]

All of this makes Medicare look so easy Now !!!!!

 

[Crabcake Johnny]

I can only speak for CA, but in CA Navigators will be paid $58 per enrolled Exchange application. It was approved last summer out here.

The problem with this is that there will likely be 50 differing versions of PPACA implemented just to add to the confusion.

Agreed - since the roles will be defined by the states it'll be a rat's nest. A MD DOI contact last year told me that it's an insurance violation for a carrier to pay a commission to anyone without a license, hence navigators cannot get a "per app" fee of any kind.

HHS: States can license navigators | LifeHealthPro

If you read this paragraph, it seems clear that HHS doesn't want navigators acting as agents:

"HHS officials startled Nevada insurance regulators this summer by rebuffing state efforts to license navigators as producers."

I couldn't find more info about this. Does "rebuffing their efforts" mean they flat out told NV that navigators cannot also be producers?

 

[Yagents]

Nav's are never paid by the insurance companies. They are paid by the exchange. Initially through the grants, then through exchange fees in future years.
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Will an Exchange health insurance purchase process be a single session, or will it likely be a 2 (or more) step process?

I'm having a hard time believing that a consumer will be able to sit down at a computer, fill out the subsidy application and get an instant authorization for .xx per month and proceed to apply for a Catastrophic, Bronze, Silver, etc. plan.

Won't the treasury department computer need to go through a litany of internal searches to ascertain the amount Mr. Doe will qualify for? I envision it being more like a background check that takes at least 24 hours to complete. If a consumer enters his/her 2012 income and it's off by a few dollars, the process would grind to a halt until it's accurately entered.

-ac

CMS outlines the PPACA exchange record system | LifeHealthPro

An exchange program "Data Services Hub" will help exchanges get eligibility information and check applications by pulling data from the Internal Revenue Service, the Social Security Administration, the U.S. Department of Homeland Security, the U.S. Department of Veterans Affairs, the U.S. Department of Defense, the Peace Corps and the federal Office of Personnel Management.

In addition to names, contact information and health coverage information, the types of data that could be stored in the record system could include information about whether an individual is incarcerated, the individual's religion, the individual's household income, and information about whether an individual is pregnant.

 

[stuy119]

I sat in on a seminar today detailing more info about the PPACA, sales opportunities, IL exchanges, etc. The gentleman who gave the seminar has been involved with different legislative scenarios, including those involving HHS and our state commissioner and treasurer. TIFWIW, but he had some thoughts and made some statements about what to expect:

1. IL is expecting to pay agents for their work outside AND INSIDE the exchange. The commissioner said that he sees the value agents bring to the table.

2. Commissions are likely to be a percentage rather than a per month or per head rate, paid directly via the carrier.

3. He expects rates to jump, and the percentage of commission to be paid on A TOTAL PREMIUM BASIS, not just non-subsidized premium.

4. Plan names are likely to standardize across the IFP and group markets.

5. There were some valuable sales tools to illustrate that disbanding a group will hurt some workers. This is most likely to apply to major markets, but the Chicagoland area is going to see A LOT of unhappy people based on their lack of subsidies due to incomes.

There was some other stuff, but that was the basic gist of what I heard on broker involvement. Opportunities, but no idea how things will shake out in the end.

 

[Ann H]

Thank you for sharing that Stuy119. You gleaned some good information from that seminar.

 

[Dave020]

1. IL is expecting to pay agents for their work outside AND INSIDE the exchange. The commissioner said that he sees the value agents bring to the table.

I expect that will be the overall model. CA approved it last summer equal commission inside and outside paid by the carriers

2. Commissions are likely to be a percentage rather than a per month or per head rate, paid directly via the carrier.

Heard similar yesterday. Rumor of PMPM Flat was an idea out here under consideration of our larger Blue, but was shelved quite some time ago. Some of their reps are still saying it but I heard they looked at it, didn't value it for agents, and scrapped it in favor of another model (%).

4. Plan names are likely to standardize across the IFP and group markets.

CA will have three sets of plans, inside exchange, outside copycat plans (duplicate of exchange offerings) and plans developed and sold specifically outside only. The plans sold specifically outside will only have to conform to a Metal tier and contain the EHB, otherwise they will differ in things like provider network, drug benefits/formulary and so on.

 

[stuy119]

Oh, also, two more quick things:

1. The IL plans are rumored to be modeled around BCBS group plans. That means that IFP plans will have infertility, weight reduction surgery, and (as we knew) maternity coverage.

2. Rates are currently expected to increase by 100% (or more) on IFP plans. The expectation is that group plans will see little to no increase in IL, as we already mandate many of the EHB's under the group plans.

Bonus nugget: this was put on by a GA who mainly works with BCBS and Humana. Both are considering early renewals for all groups to allow employers and employees to have an "apples to apples" shopping comparison process.

 

[pahealthquotes]

100% rate increase on IFP? Yowzer.

 

[smitty619vt]

As a licensed agent in CA selling on the exchange. From what I understand so far..... The commissions will be the same for in or out of the exchange in 2014.

My question is: Will we get a commissions % from the premium before the subsidy amount or after ? So if somebody's premium is lets say $600 a month and they get a $200 subsidy making there monthly premium $400. What is the commission based off $600 or $400 ?

 

[somarco]

100% rate increase on IFP? Yowzer.

Please tell me you didn't buy into the BHO promise of lower premiums.

For some, 2x their current rate is a low estimate. Especially true if they have a HDHP with $5k or higher deductible.