- Thread starter
- #11
Finally getting some recognition. Scroll down to "What's the Debate"
Health Policy Briefs
What's The Debate?
Questions About Future Navigator Funding May Increase The Role For Brokers
Many insurance agents and brokers (collectively referred to as brokers) did not embrace the ACA and had concerns about unlicensed individuals and groups providing advice on private insurance products. (An insurance agent typically works on behalf of one or more insurance companies, while an insurance broker typically works on behalf of the customer seeking insurance.) In some cases, brokers lobbied states to pass laws imposing additional requirements and restrictions on navigators and IPAs (see discussion below). But as funding for navigators decreased for the second open enrollment period, some states began cultivating a closer relationship with brokers to maximize enrollment.
A few states such as California and Kentucky engaged brokers from the beginning. In California, 39 percent of people who enrolled through the state's exchange used a broker; while in Kentucky, 44 percent did. But other states initially seemed reluctant to embrace brokers. When exchanges experienced problems with their websites, many states began to more aggressively refer customers to brokers for additional help.
For the first two open enrollment periods, Get Covered Illinois received a total of $125 million in federal funds, but with uncertainty over ongoing federal navigator funding, the state began planning for increased broker engagement to sustain long-term enrollment in qualified health plans. Get Covered Illinois launched its Producer Program in 2014, offering to fund co- branded advertisement with brokers and give them priority listing on the Marketplace website, in exchange for enrollment commitments from them. During the initial round of the program--the second open enrollment period--eleven agencies were selected at the highest level, Producer Ambassador, in addition to more than 140 Producer Partners who completed the online training and were listed as official Get Covered Illinois sponsors.
There are several advantages to using brokers to help fill some consumer assistance needs, especially in states where consumer assistance funding is stretched thin. Many brokers have decades of experience working with insurers and have existing relationships with small businesses and individuals who are shopping on the Marketplace. In some cases, brokers may have more experience than the call-center staff available to answer consumers' questions. Brokers are not prohibited from making insurance recommendations, and customers may benefit from brokers' experience in suggesting what health plans will serve them best.
However, there are some important distinctions between navigators and assisters, which are often nonprofit, community-based organizations, and insurance brokers. Navigators and IPAs are required under the ACA to perform outreach and education activities as well as make information available to non-English speakers. Navigators and IPAs receive funding through federal, state, and private grants as well as through the Marketplaces. The ACA requires navigators and IPAs to offer unbiased information and prohibits them from making health plan recommendations.
Brokers generally receive a commission directly from the insurer whose policy was sold and are not required by law to inform customers about all policies available. Some advocates have argued that Marketplaces should use only independent brokers (as opposed to brokers affiliated with a particular insurance company) and that the commission should be paid through the Marketplace, instead of directly from the plan.
Although brokers are likely to play an integral role in enrollment and reenrollment going forward, prior to the ACA they typically served people looking to purchase private insurance, a population more likely to be white and have a higher income than the hard-to- reach population that Marketplaces are currently trying to enroll.
Likewise, brokers may not be familiar with means-tested programs (programs that require individuals to meet income guidelines) such as Medicaid.
According to a 2015 Kaiser Family Foundation survey of assister programs and brokers, there were some important differences in the clients served by assisters and brokers. Assisters, as compared with brokers, were more likely to help low-income and previously uninsured clients, Latino customers, and clients needing language translation services. For example, only 8 percent of brokers reported that most or nearly all of their clients had incomes low enough to qualify for Medicaid, compared with 50 percent of assisters.
In most states, brokers are not compensated for customers found to be eligible for Medicaid, and they generally refer such customers to navigators or other organizations instead of helping them enroll. A long-term strategy that relies on brokers may not bring in the hard- to-reach and low-income populations that must be enrolled in order for the percentage of the uninsured to continue its downward trend.
Consistency In Navigators
This year represents the third grant cycle for navigators and assisters. The first two grants were for one year each and were not renewable. Navigator and assister organizations needed to reapply each year for grants, a time-consuming and unpredictable process. In nearly every state using the federal Marketplace, there was some turnover in navigators from year to year. In some areas, such as Kansas City, Missouri, community organizations complained about the change in navigator organization. Advocates in Kansas City were happy with the work of the navigator the first year, a local nonprofit organization working with seniors, and questioned the federal government's awarding the second-year grant to a privately owned company whose background was in helping hospitals increase revenue by exploring possible coverage sources for uninsured patients.
Of the 2014 federal navigator grants, there were more organizations operating across multiple states to provide navigator services compared with 2013. In some cases, the national or regional companies replaced local community-based organizations that received funding the first year. Of the recently awarded 2015 navigator grants, however, there were fewer grants to privately held companies in favor of more community-based organizations.
For the third open enrollment period, HHS is offering three-year grants, funded in twelve-month increments. In addition, after decreasing navigator grants from $67 million in year one to $60 million in year two, HHS restored the original $67 million budget for 2015.
Evolving Role Of Navigators May Be Beyond Their Scope And Capability
Assisters' core mission is focused on enrolling people into a health plan. Once people obtain insurance, any problems should be directed to the insurer or Medicaid agency, the Department of Insurance, or state organizations created to help them with grievances or appeals. But both the Kaiser Family Foundation and the Robert Wood Johnson Foundation found that assisters were faced with many postenrollment questions.
The 2014 KFF survey found that 90 percent of assisters reported receiving postenrollment questions. Issues included consumers not receiving their insurance card (54 percent) or understanding how to use their insurance (44 percent), complaints about the provider not being in network (37 percent), and claim denials (21 percent).
While some of these issues fall within the scope of assisters, others such as claim denials do not. The KFF survey found that assisters worked to help consumers try to resolve these issues even if they were beyond the assisters' scope and the assisters lacked training to do so. For many people, assisters may be their only face-to-face contact during the enrollment process, so it is natural that they would return to assisters when they experience problems or have questions.
In addition to postenrollment questions, a number of issues encountered by assisters require policy and legal expertise that they may not possess. The report from the Navigator Technical Assistance Project suggests providing different levels of training so that organizations would have some staff capable of handling the most complex issues while the remaining staff work with the easier enrollment issues.
Health Policy Briefs
What's The Debate?
Questions About Future Navigator Funding May Increase The Role For Brokers
Many insurance agents and brokers (collectively referred to as brokers) did not embrace the ACA and had concerns about unlicensed individuals and groups providing advice on private insurance products. (An insurance agent typically works on behalf of one or more insurance companies, while an insurance broker typically works on behalf of the customer seeking insurance.) In some cases, brokers lobbied states to pass laws imposing additional requirements and restrictions on navigators and IPAs (see discussion below). But as funding for navigators decreased for the second open enrollment period, some states began cultivating a closer relationship with brokers to maximize enrollment.
A few states such as California and Kentucky engaged brokers from the beginning. In California, 39 percent of people who enrolled through the state's exchange used a broker; while in Kentucky, 44 percent did. But other states initially seemed reluctant to embrace brokers. When exchanges experienced problems with their websites, many states began to more aggressively refer customers to brokers for additional help.
For the first two open enrollment periods, Get Covered Illinois received a total of $125 million in federal funds, but with uncertainty over ongoing federal navigator funding, the state began planning for increased broker engagement to sustain long-term enrollment in qualified health plans. Get Covered Illinois launched its Producer Program in 2014, offering to fund co- branded advertisement with brokers and give them priority listing on the Marketplace website, in exchange for enrollment commitments from them. During the initial round of the program--the second open enrollment period--eleven agencies were selected at the highest level, Producer Ambassador, in addition to more than 140 Producer Partners who completed the online training and were listed as official Get Covered Illinois sponsors.
There are several advantages to using brokers to help fill some consumer assistance needs, especially in states where consumer assistance funding is stretched thin. Many brokers have decades of experience working with insurers and have existing relationships with small businesses and individuals who are shopping on the Marketplace. In some cases, brokers may have more experience than the call-center staff available to answer consumers' questions. Brokers are not prohibited from making insurance recommendations, and customers may benefit from brokers' experience in suggesting what health plans will serve them best.
However, there are some important distinctions between navigators and assisters, which are often nonprofit, community-based organizations, and insurance brokers. Navigators and IPAs are required under the ACA to perform outreach and education activities as well as make information available to non-English speakers. Navigators and IPAs receive funding through federal, state, and private grants as well as through the Marketplaces. The ACA requires navigators and IPAs to offer unbiased information and prohibits them from making health plan recommendations.
Brokers generally receive a commission directly from the insurer whose policy was sold and are not required by law to inform customers about all policies available. Some advocates have argued that Marketplaces should use only independent brokers (as opposed to brokers affiliated with a particular insurance company) and that the commission should be paid through the Marketplace, instead of directly from the plan.
Although brokers are likely to play an integral role in enrollment and reenrollment going forward, prior to the ACA they typically served people looking to purchase private insurance, a population more likely to be white and have a higher income than the hard-to- reach population that Marketplaces are currently trying to enroll.
Likewise, brokers may not be familiar with means-tested programs (programs that require individuals to meet income guidelines) such as Medicaid.
According to a 2015 Kaiser Family Foundation survey of assister programs and brokers, there were some important differences in the clients served by assisters and brokers. Assisters, as compared with brokers, were more likely to help low-income and previously uninsured clients, Latino customers, and clients needing language translation services. For example, only 8 percent of brokers reported that most or nearly all of their clients had incomes low enough to qualify for Medicaid, compared with 50 percent of assisters.
In most states, brokers are not compensated for customers found to be eligible for Medicaid, and they generally refer such customers to navigators or other organizations instead of helping them enroll. A long-term strategy that relies on brokers may not bring in the hard- to-reach and low-income populations that must be enrolled in order for the percentage of the uninsured to continue its downward trend.
Consistency In Navigators
This year represents the third grant cycle for navigators and assisters. The first two grants were for one year each and were not renewable. Navigator and assister organizations needed to reapply each year for grants, a time-consuming and unpredictable process. In nearly every state using the federal Marketplace, there was some turnover in navigators from year to year. In some areas, such as Kansas City, Missouri, community organizations complained about the change in navigator organization. Advocates in Kansas City were happy with the work of the navigator the first year, a local nonprofit organization working with seniors, and questioned the federal government's awarding the second-year grant to a privately owned company whose background was in helping hospitals increase revenue by exploring possible coverage sources for uninsured patients.
Of the 2014 federal navigator grants, there were more organizations operating across multiple states to provide navigator services compared with 2013. In some cases, the national or regional companies replaced local community-based organizations that received funding the first year. Of the recently awarded 2015 navigator grants, however, there were fewer grants to privately held companies in favor of more community-based organizations.
For the third open enrollment period, HHS is offering three-year grants, funded in twelve-month increments. In addition, after decreasing navigator grants from $67 million in year one to $60 million in year two, HHS restored the original $67 million budget for 2015.
Evolving Role Of Navigators May Be Beyond Their Scope And Capability
Assisters' core mission is focused on enrolling people into a health plan. Once people obtain insurance, any problems should be directed to the insurer or Medicaid agency, the Department of Insurance, or state organizations created to help them with grievances or appeals. But both the Kaiser Family Foundation and the Robert Wood Johnson Foundation found that assisters were faced with many postenrollment questions.
The 2014 KFF survey found that 90 percent of assisters reported receiving postenrollment questions. Issues included consumers not receiving their insurance card (54 percent) or understanding how to use their insurance (44 percent), complaints about the provider not being in network (37 percent), and claim denials (21 percent).
While some of these issues fall within the scope of assisters, others such as claim denials do not. The KFF survey found that assisters worked to help consumers try to resolve these issues even if they were beyond the assisters' scope and the assisters lacked training to do so. For many people, assisters may be their only face-to-face contact during the enrollment process, so it is natural that they would return to assisters when they experience problems or have questions.
In addition to postenrollment questions, a number of issues encountered by assisters require policy and legal expertise that they may not possess. The report from the Navigator Technical Assistance Project suggests providing different levels of training so that organizations would have some staff capable of handling the most complex issues while the remaining staff work with the easier enrollment issues.
