2016 Survey of Health Insurance Marketplace Assister Programs and Brokers

Discussion

The new ACA system for in-person enrollment assistance through Marketplaces is becoming well established.  The vast majority of Programs have operated for three years and most of their staff have worked all three years, as well.  With tenure comes increasing expertise with Marketplace rules and procedures and familiarity with communities served.  There are now opportunities to build on the strengths of the most seasoned Programs and Assisters – perhaps offering more in-depth training and continuing education to develop specialized skills.

Fewer consumers were helped by Assister Programs this year.  Perhaps not coincidentally, the annual rate of Marketplace enrollment growth slowed this year, as well.  Investing in consumer assistance could help to increase enrollment, although those investments have to compete against other needs in federal, state, and marketplace budgets.  Evidence suggests consumers’ need for in-person help won’t go away any time soon:  an increasing share of consumers seeking help this year were renewing vs. applying for the first time; most still have limited understanding of health insurance and the ACA; and many still lack confidence to apply on their own.  There is also substantial churn in Marketplace enrollment – for example, as people gain or lose jobs with health benefits – creating an influx of new consumers seeking coverage and in-person help between Open Enrollment periods.

Uncertainty is also a challenge for Assister Programs, with one in three not certain that funding will be available next year.   The FFM has reduced funding uncertainty by adopting multi-year agreements with Assister Programs, though the amount of funding is decided year-by-year.

The survey reveals that the bulk of consumer help through Assister Programs is provided by a minority of large Programs–80% of all consumers helped in OE3 were served by just one-quarter of all Assister Programs.  These large-caseload Programs include Navigators, which contract directly with Marketplaces, and FQHC and CAC Programs, which are certified by Marketplaces but not necessarily as familiar to Marketplace officials.  Large caseload Programs may provide the greatest opportunity for improving consumer assistance in the future; however, these programs face resource constraints and were the most likely to say that demand for help exceeded their capacity to provide it, especially during surge times.

Assisters continue to report that it takes 90 minutes on average to help new Marketplace participants, and 60 minutes on average for returning consumers.  That the process remains time intensive, even after IT systems have improved, indicates how complicated the application process can be for consumers.  Consumers face particular challenges when “real time” data verification and file transfers don’t work, and significant delays and enrollment barriers can result.  It appears that many, if not most individuals who experience data verification difficulties are not being helped by Assister Programs.

Brokers, who have emerged as an important avenue for marketplace enrollment, are, not surprisingly, concerned about the loss of revenue as insurance companies reduce or end commissions, actions taken most often this year for SEP enrollments.  Millions of consumers are estimated to become eligible for SEPs during the year, but only a fraction take up the opportunity to enroll.¹  SEP enrollments can help offset normal churn of individuals who return to group health plans or public coverage during the year.  Loss of broker commissions, combined with adoption of new SEP eligibility verification requirements by the FFM, could dampen Marketplace enrollment.

The survey shows that brokers in FFM states rely heavily on alternative enrollment channels, especially to the extent these offer enhanced functionality.  However, little is known about the experiences of consumers who apply through them or how often consumers buy other products through these sites, such as short-term policies or plans that target specific diseases.

Finally, Assisters and brokers on the front lines have valuable insights into how health reforms are working for consumers.  Lower cost sharing in Marketplace health plans was identified as a priority by both Assister Programs and brokers.  Reducing cost sharing presents tradeoffs – increasing premiums or government subsidies for low-income consumers – but could also be a factor helping to sustain enrollment growth.