HealthCare.gov Managers Talk About Agent Comp

Public health insurance exchange plan issuers should try to work with agents and brokers to clear up compensation problems related to missing National Producer Numbers (NPN), according to HealthCare.gov managers.

(Related: The NIPR Has Your Number)

Representatives from HealthCare.gov, the federal government's web-based health insurance supermarket program talked, a little, about producer compensation last week, during a webinar aimed at producers who may sell the plans available through HealthCare.gov for 2018.

HealthCare.gov's own staff calls HealthCare.gov "the Marketplace."

"If you have reason to believe that your NPN (or agency/brokerage NPN) should have been included on a Marketplace enrollment transaction, but was not, you may contact the respective [exchange plan] issuer directly to discuss the situation," HealthCare.gov managers say in a webinar slidedeck.

The HealthCare.gov team thinks an exchange plan issuer "would issue compensation if it is determined from the issuer's or your records that you did in fact assist the consumer, but the NPN was erroneously left off of the enrollment," HealthCare.gov managers say in the slidedeck.

"Such records may include a consent form from the consumer, an issuer's broker of record form, or similar documentation to demonstrate that the consumer was your client for the enrollment in question," the managers say.

The HealthCare.gov managers do not offer to help producers resolve disputes with the coverage issuers over problems with collecting fees or commissions.

The exchange managers note that the federal government does set agent compensation levels for the Medicare Advantage program, but not for the Affordable Care Act public exchange program.

State insurance regulators and state-based Affordable Care Act public exchange programs may set their own, state-specific exchange plan producer compensation standards, but, otherwise, exchange plan producer compensation levels are something for producers to negotiate with the coverage issuers, HealthCare.gov managers say.

HealthCare.gov managers posted the webinar slidedeck on a semiprivate technical support website.

HealthCare.gov Basics

Health insurance agents, brokers, issuers and dot.coms talked about setting up menu-based, and, later, web-based health insurance supermarkets for individuals and small employers for decades.

(Image: Allison Bell/TA)

In some cases, business groups, state governments and dot.coms set up small exchange programs, but they ran into problems with antitrust concerns, and with the difficulty of dealing with medical underwriting obstacles.

In 2009, when Democrats in Congress were writing the legislation that created the Affordable Care Act, they developed the public exchange provisions to serve as a market-oriented alternative to having government agencies offer Medicare-like "public option" plans throughout the country.

A public exchange program is supposed to give consumers a simple ways to shop for coverage from private health insurers online, and to use the ACA premium tax credit subsidy and cost-sharing reduction subsidy to hold down their share of the health insurance premium bills.

Originally, Democrats in Congress assumed that most states would set up their own public exchange programs. The U.S. Department of Health and Human Services set up HealthCare.gov to run the health insurance supermarkets in states that were unwilling or unable to handle the job themselves.

The Centers for Medicare and Medicaid Services, an arm of HHS, runs HealthCare.gov. The Center for Consumer Information and Insurance Oversight is the CMS division directly in charge of HealthCare.gov.

HealthCare.gov now provides exchange account setup and account administration services in 37 states.

Insurance agents and brokers have been having a hard time getting paid to sell individual health coverage this year, are not sure what the big Affordable Care Act subsidy fight in Washington will do to the 2017 coverage they've sold, and are hazy on which insurers might offer individual major medical coverage for 2018.

But the open enrollment period for 2018 individual major medical coverage is still set to start Nov. 1, 2018. Officials at the Centers for Medicare and Medicaid Services have been trying to prepare producers for whatever lies ahead by holding weekly producer webinars.

The 2018 open enrollment period producer webinar series started Sept. 13.

Information about upcoming webinars is available here.

The open enrollment period for 2018 is the first one to begin under the administration of President Donald Trump.

Under the Obama administration, HealthCare.gov managers said about producer compensation only that it was a matter for plans and producers to negotiate, and that plan issuers should not use producer compensation levels to discriminate between on-exchange and off-exchange plans. HealthCare.gov managers' comments about missing NPN numbers may reflect a slight increase in the managers' willingness to talk about producer compensation.

HealthCare.gov Wrinkles

HealthCare.gov managers talked about enrollment period issues other than missing National Producer Numbers during the recent webinar.

Here are some other topics managers discussed:

Compensation and producer appointments: In theory, exchange managers said, an issuer can compensate an agent for an exchange plan sale even if the agent does not have an appointment with that issuer. "Issuers have the discretion to compensate you if you do not have an appointment at the time you assisted with an enrollment, but you otherwise comply with federal and state standards," exchange managers say.

Discrimination: Although the Obama administration did not set minimum exchange plan producer compensation levels, it did require that compensation levels for similar on-exchange and off-exchange plans be the same, to keep compensation levels from pushing higher-risk enrollees either toward or away from exchange plans. If agents think an issuer is paying different levels of compensation for similar exchange and non-exchange plans, the HealthCare.gov assister help desk will help them with that, exchange managers say.

Enrollment period grace period: The enrollment period for 2016 and 2017 ran from Nov. 1 through Jan. 31.

Under the Obama administration, exchange programs found ways to extend or wiggle the enrollment period end data, in part to help consumers cope with the technical problems and other problems that cropped up near the enrollment period end dates.

This year, CMS has decided to have the enrollment period for 2018 to end Dec. 15.

For 2018, "there are no opportunities to make an open enrollment plan selection after Dec. 15," HealthCare.gov managers say.

—-Read Agents Angry About Unpaid ACA Exchange Plan Commissions on ThinkAdvisor.

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