The 2010 passage of the Patient Protection and Affordable Care Act (PPACA) caused existing private health insurance exchange GetInsured.com to tweak its online platform to comply with the new law. But the actual implementation of PPACA has been spelling additional revenue opportunities for the Palo Alto, Calif., company.
GetInsured.com was formed in 2005 to primarily serve consumers who voluntarily purchased individual health insurance plans from carriers either on its online platform or through its call centers staffed with licensed brokers, explains Shankar Srinivasan, chief operating officer and co-founder.
"We started this so that consumers could get a greater transparency to health care," Srinivasan says. "Even though it's 15 percent of the GDP, it's still very opaque."
But now that individuals and many businesses are mandated to buy insurance policies for themselves or their employees under PPACA, GetInsured.com has found a variety of ways to expand its business model to take advantage of those mandates. Those include providing the software backbone for several state exchanges, such as Covered California in partnership with Accenture, the prime contractor for that exchange, says Scott Osler, vice president of business development. GetInsured.com has also built several state Small Business Health Options (SHOP) exchanges.
See also: Private exchange picture still blurry
"With the 2010 passage of the PPACA, we recognized that states would have to build exchanges to serve their populations, and that we had the software assets and capabilities that were mature and proven," Osler says. "This was an opportunity to help states adopt our platform under a SaaS model."
Getinsured.com's story is one example of a larger trend of already-established private exchanges working to expand their business model under — and in many cases partner with — PPACA's public exchanges.
Getinsured.com and several other private exchanges, including eHealthInsurance.com, last summer signed contracts with the Centers for Medicare & Medicaid Services, to enable connectivity between the private exchanges and the federal government's HealthCare.gov, to determine consumer eligibility for tax subsidies to purchase PPACA-compliant plans.
"As with any product, consumers shop in different ways for health insurance, and we have factored this into the health insurance marketplace," says Alicia Hartinger, a CMS spokeswoman. "Direct enrollment is one of many ways we are working to offer consumers a variety of ways to enroll in affordable coverage."
While the federal government's enrollment numbers include consumers who have enrolled through the private exchanges, CMS does not currently break out those figures, Hartinger says.
Consumers can log onto GetInsured.com to preliminarily figure out how much subsidy they could get by using the site's eligibility estimator tool, Srinivasan says. But to officially validate whether in fact they actually do qualify — and for how much, consumers currently have to then click a link that redirects them to the federal HealthCare.gov, which uses IRS information to calculate any subsidies.
The federal site then redirects consumers back to GetInsured.com to complete the enrollment application, and then they are redirected to the website of the carrier of their chosen plan to make their first policy payment.
The state exchanges haven't developed this capability yet, Srinivasan says, so consumers applying for plans on GetInsured.com are urged to call the company's brokers, who then log onto state databases to confirm eligibility for subsidies. The brokers then offer to stay on the phone to guide consumers through the rest of the enrollment process, including payment.
