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The Affordable Care Act According to Health Insurance Agents


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The Department of Health and Human Services, or HHS, recently reported that 4 million Americans have signed up for private health insurance plans through the federal and state-based marketplaces of the Affordable Care Act, or ACA. Open enrollment closes March 31, so the government has just over a month to get an additional 2 million people to sign up to reach its goal of 6 million. Those seeking health insurance can enroll through HealthCare.gov, via the government call center, on third-party marketplace sites such as eHealth, or in person with a government-certified navigator or health insurance agent.

The latest detailed report of enrollment includes information about gender and age distribution for those who have enrolled, as well as the type of plan they have selected -- but it remains to be seen how things will shake out come March 31. Health insurance agents who are certified to sell marketplace plans are very knowledgeable about the plans themselves -- not to mention the insurance shoppers they've been working with since October. Here is how enrollment looks -- from the insurance agent's perspective.

Which types of plans are health insurance shoppers interested in?
Enrollment numbers say Silver plans are the most popular, accounting for 62% of marketplace plans that have been selected. According to Jeffrey D. Peterson, a certified agent for Covered California, California's health insurance marketplace, "Silver is the hot metal tier." The reasoning, he says, is that only Silver plans have "cost-sharing reductions ... [which] lower copays and deductibles, and many people qualify for both the subsidy and the cost-sharing reduction." Find out if you qualify for cost-sharing reductions -- your savings will depend on your income.

Some agents, however, see a trend toward higher-metal tiers. John W. Seltzer of J. Seltzer Associates in Pennsylvania says all of his clients are selecting Gold or Platinum plans. He says "metal levels are meaningless since there is no basis to compare plans of each metal level between carriers or even within the same carrier." While the Obama administration touts the importance of "apples-to-apples" comparisons across plans, it's possible that some consumers can't grasp this concept -- and, therefore, that its utility is lost on many insurance shoppers.

What problems are people encountering?
Problems with the rollout of the ACA have not been limited to website glitches. Some people have encountered issues even after successfully purchasing a plan. Kevin Murray of The HIQS Group in Connecticut spoke of clients whose physician and facility accepted their insurance carrier -- but "they would not accept the coverage [because] it was specifically an Exchange product. ... [T]hese clients were faced with the out-of-network, out-of-pocket maximum of $36,000."

Others face the problem of a large deductible. According to Murray, many receive a "substantial premium subsidy," which makes monthly premiums affordable. In fact, HHS reports that 82% of enrollees thus far have selected a plan with financial assistance. Many of these plans, however, will still require enrollees "to fulfill a large deductible expense." This means that -- besides free preventive screenings -- these policyholders will have to pay the full price for many health services until they reach their thousands-of-dollars deductible.

What do sign-up demographics look like?
According to HHS, 31% of people who have selected a plan are between ages 0 and 34. That puts 69% of enrollees over 35 years of age -- outside of the "young invincible" demographic and more prone to health problems. According to Peterson, many enrollees are coming with pre-existing conditions, including cancer, diabetes, high blood pressure, and pregnancy. Chronic conditions, which can be very costly to insurance companies, seem quite prevalent -- Peterson says, "the number fighting cancer seems much higher than we expected."

What needs improvement?
Everyone seems to have an opinion of the ACA and his or her own ideas about what needs to be done to change it. Insurance agent Ken Matheson hopes to see improvements in "technology, training, [and] information communication." He points to software glitches, as well as understaffing for the marketplace.

"I can't think of another industry where people are on hold for several hours, and people are actually so desperate for help that they do hold for several hours," he said.

It's clear that many people stand to benefit from the ACA, but enrolling these people and making sure they get access to the appropriate coverage is proving to be a big challenge -- for the government, for insurance agents, and for the individuals who are going through the enrollment process.


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