Agents mobilize for ACA exchange plan scrambler week

HealthCare.gov managers are gearing up to shuffle stranded exchange plan enrollees into new plans next week.

The Affordable Care Act individual health insurance open enrollment period for 2017 coverage starts Nov. 1. Analysts have estimated that plan withdrawals could affect one-third or more of the enrollees in many states.

HealthCare.gov developed the "crosswalking" system to keep consumers affected by the discontinuation of 2016 exchange plans from losing health coverage simply because the issuers drop the plans.

If an enrollee in an exchange plan that's going away fails to choose a substitute plan for 2017, HealthCare.gov will suggest a plan, according to officials at the Centers for Medicare & Medicaid Services, the federal agency that runs HealthCare.gov.

A consumer affected by a HealthCare.gov crosswalk will generally have to make a binder payment to effectuate an enrollment, CMS officials say in a note about how the crosswalk system will work.

Officials in some states, including Wisconsin, have said the crosswalk system violates the rules in effect in their states. In those states, CMS is letting consumers opt out of the crosswalk system.

Health Agents for America, a Baton Rouge, Louisiana-based agent group, says it's not clear what will happen to commissions for the agents of current exchange plan enrollees, or whether the current exchange plan enrollees' National Producer Numbers will stick with the application files of consumers crosswalked into new plans.

"Please check with the carriers in your state to verify," HAFA says in an e-mail bulletin.

HAFA says agents should tell clients about their coverage options. (Image: Thinkstock)

S&P says the future could look better

The current turmoil could cause big problems for ACA exchange plan managers and the individual health insurance market in 2018, but analysts at New York-based Standard & Poor's Financial Services say there's still hope for an exchange system recovery.

Many of the insurers that are still selling individual medical major coverage in 2017 are cutting or eliminating agent compensation, especially in the exchange market.

One, Hartford, Connecticut-based Aetna, sent producers a bulletin saying it will stop paying individual health commissions for 2017 in Arkansas, Arizona, Illinois, Kansas, Kentucky, Louisiana, Michigan, New Jersey, Ohio, Pennsylvania, Tennessee, Texas, Utah and Wyoming, according to Henry Stern, an Ohio-based agent who blogs at InsureBlog.

HAFA says agents have a duty to call clients affected by the exchange plan shuffle.

"You need to contact all of your customers who have policies with a carrier leaving the market and let them know CMS will choose a plan for them," HAFA says. "You will have the opportunity to put them in a plan that works for them during open enrollment."

But Deep Banerjee and other analysts at S&P say in a new commentary that the Affordable Care Act premium tax credit subsidy should help stabilize ACA exchange plan enrollment, in spite of the turmoil.

Thanks to the subsidies, the number of people with plan selection information in the ACA exchange system around Jan. 31, at the end of the 2017 open enrollment period could range from 11.7 million to 13.3 million, compared with 11.7 million at the end of the 2016 open enrollment period, the analysts say.

Actual 2017 paid enrollment total could range from 10.2 million to 11.6 million, compared with 11.1 million for 2016, the S&P analysts say.

"As we have said previously, we expect a five-year path to stability in the exchange business," the analysts say. "During this period, pricing corrections by insurers are an unwelcome but somewhat needed side effect of the evolving insurance marketplace."

If the current system stays in effect, price increases are likely to be moderate in 2018, and that should help exchange plan sales grow, the analysts say.

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