Thousands of brokers exit HealthCare.gov as plan commissions go unpaid
Skip to main content
MDHC_Logotype_white
Subscribe
  • My Account
  • Login
  • Subscribe
  • News
    • This Week's News
    • COVID-19
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • People
    • Regional News
    • Digital Edition
    • Feds shouldn't lose sight of drug misuse epidemic, GAO says
      OU Health Physicians, Oklahoma Blues plan fail to reach new contract
      NIH, partners commit $74.9M to new phase of Alzheimer's program
      COVID, one year later: New York hospital execs reflect on lessons learned
    • COVID, one year later: New York hospital execs reflect on lessons learned
      Senate Dems sorting final details of $1.9T virus relief bill
      White House: Merck to help produce rival J&J's vaccine
      Blue Cross NC claims costs rise thanks to COVID
    • Shareholder group calls out HCA for alleged excessive emergency department admissions
      Metrologo 600x400_i.jpg
      MetroHealth forms Center for Cancer Research
      The Check Up: Dr. Marc Boom
      The Check Up: Dr. Marc Boom of Houston Methodist
      Dr. Marc Boom
      Q&A: Houston Methodist CEO praises staff efforts to keep vaccine efforts going during ice storm
    • OU Health Physicians, Oklahoma Blues plan fail to reach new contract
      Blue Cross NC claims costs rise thanks to COVID
      BlueCrossBlueShieldSign-main_i_i_i.jpg
      Michigan Blues post lowest operating profits in four years amid COVID-19 pandemic
      Highmark, HealthNow finalize affiliation, creating fourth-largest Blues plan
    • Feds shouldn't lose sight of drug misuse epidemic, GAO says
      House health panel chair says it's time to make Medicare telehealth permanent
      Pandemic raises questions about impact of Medicare pay restructuring in long-term care
      Proposed overhaul of Arkansas Medicaid expansion unveiled
    • UPMC's patient volumes stabilize, boosting 2020 profits
      Genomics firms taking advantage of SPACs trend to go public faster
      COVID-19 could dent hospital revenue by at least $53 billion in 2021, AHA says
      deloitte GDP image chart graph going up
      Sponsored Content Provided By Deloitte
      Breaking the cost curve
    • Teladoc reports $383.3M in fourth-quarter revenue, up 145%
      man and woman looking at ipad wearing face masks stock image
      Sponsored Content Provided By Surescripts
      Improvements to benefits data can enhance ePrescribing and the patient experience
      Oscar Health's $1B IPO sets the stage for more health tech exits in 2021
      A map of the U.S. with images of the coronavirus.
      The digital divide becomes a new social determinant of health
    • Highmark Health partners with Verily subsidiary on chronic care issues
      Children's mental healthcare needs skyrocket during pandemic
      Tensions over vaccine equity pit rural against urban America
      Utah cancels vaccine appointments after registration error
    • Alicia Wilson
      Q&A: Emerging leader Alicia Wilson on staying close to home
      Michael Jordan, Novant team up to address health equity
      Former Ascension CEO, the first to lead the health system, passes away
      Biden's pick to head CMS would be first Black woman to hold post
    • Midwest
    • Northeast
    • South
    • West
  • Insights
    • ACA 10 Years After
    • Best Practices
    • Special Reports
    • Innovations
    • The Affordable Care Act after 10 years
    • Dr. John Fischer
      Patient-reported outcomes tool for hernia surgery helps physicians improve care
      New care model helps primary-care practices treat obesity
      doctor with patient
      COVID-19 treatment protocol developed in the field helps patients recover
      Rachel Wyatt
      Project to curb pressure injuries in hospitals shows promise
    • What's next for on-demand telehealth companies?
      A CalOptima PACE vaccination clinic.
      Will COVID-19 be the catalyst for creating a more sustainable healthcare system?
      A map of the U.S. with images of the coronavirus.
      The digital divide becomes a new social determinant of health
      Ascension’s St. Mary’s Hospital Surgery Center at Towne Centre and Allegheny Health Network’s Bethel Park surgery center
      Hospitals see opportunity, risk in ambulatory surgery centers
    • Dr. Daniel Hall
      UPMC pilots machine learning, telehealth to inform patient transfers
      A woman being recorded using her inhaler on a smartphone.
      Digital check-ins, connected inhalers help control asthma
      A phone screen showing the question, "Mary we hope this information was helpful and we'd like to keep guiding you. Are you interested in knowing when it's your turn to receive the vaccine?"
      Chatbots, texting campaigns help manage influx of COVID vax questions
      A woman with a wearable sensor talking to her provider.
      Wearable sensors help diagnose heart rhythm problems in West Virginia
  • Transformation
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • What's next for on-demand telehealth companies?
      Rising prescription copays drop adherence, spike mortality, research shows
      Dr. John Fischer
      Patient-reported outcomes tool for hernia surgery helps physicians improve care
      Highmark Health inks six-year cloud, tech deal with Google
    • Hospitals' Medicare billing practices suggest upcoding, OIG says
      California hospitals prepare ethical protocol to prioritize lifesaving care
      Amazon, JPMorgan Chase, Berkshire Hathaway disband Haven
      Digital pathways poised to reshape healthcare continuum in 2021
    • Dr. Daniel Hall
      UPMC pilots machine learning, telehealth to inform patient transfers
      A woman being recorded using her inhaler on a smartphone.
      Digital check-ins, connected inhalers help control asthma
      Humana partners with in-home provider for 24/7 care
      A phone screen showing the question, "Mary we hope this information was helpful and we'd like to keep guiding you. Are you interested in knowing when it's your turn to receive the vaccine?"
      Chatbots, texting campaigns help manage influx of COVID vax questions
    • Bundled payments reduce surgery costs by 10.7%
      Coordinated payment policies could speed transition to value, experts say
      CMMI's geographic direct contracting model needs an overhaul, experts say
      Hospitals fight UnitedHealthcare policies over lab test, specialty drug payments
  • Data/Lists
    • Rankings/Lists
    • Interactive Databases
    • Data Points
    • Health Systems Financials
      Executive Compensation
      Physician Compensation
  • Op-Ed
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
    • Dr. Alan Kaplan
      The risks, rewards of taking organizations 'where they haven’t gone before'
      Wellstar CEO calls adapting for the pandemic her bold move
      Howard P. Kern
      Recognizing the value of telehealth in its infancy
      Dr. Stephen Markovich
      A bold move helped take him from family doctor to OhioHealth CEO
    • Dr. Stephen Markovich
      Making sure we're aligned along the path to achieving inclusion
      Barry Ostrowsky
      Ending racism is a journey taken together; the starting point must be now
      Laura Lee Hall and Gary Puckrein
      Increased flu vaccination has never been more important for communities of color
      John Daniels Jr.
      Health equity: Making the journey from buzzword to reality
    • Vaccinating children could be the key to ending the pandemic
      Mikelle Moore
      The promising future of rural healthcare, even amid the COVID-19 pandemic
      In-person visitation must be part of the national COVID-19 response
      We've lost so much to the pandemic, but we've also made gains that will endure
    • Letters: Eliminating bias in healthcare needs to be ‘deliberate and organic’
      Letters: Maybe dropping out of ACOs is a good thing for patients
      Letters: White House and Congress share blame for lack of national COVID strategy
      Letters: VA making strides to improve state veterans home inspections
    • Sponsored Content Provided By Optum
      How blockchain could ease frustration with the payment process
      Sponsored Content Provided By Optum
      Three steps to better data-sharing for payer and provider CIOs
      Sponsored Content Provided By Optum
      Reduce total cost of care: 6 reasons why providers and payers should tackle the challenge together
      Sponsored Content Provided By Optum
      Why CIOs went from back-office operators to mission-critical innovators
  • Awards
    • Award Programs
    • Nominate
    • Previous Award Programs
    • Other Award Programs
    • Best Places to Work in Healthcare Logo for Navigation
      Nominations Open - Best Places to Work in Healthcare
      Nominations Open - 50 Most Influential Clinical Executives
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Minorities in Healthcare
      • - Luminaries
      • - Top 25 Minority Leaders
      • - Minorities to Watch
    • Women in Healthcare
      • - Luminaries
      • - Top 25 Women Leaders
      • - Women to Watch
    • Excellence in Nursing Awards
    • Design Awards
    • Top 25 COOs in Healthcare
    • 100 Top Hospitals
    • ACHE Awards
  • Events
    • Conferences
    • Galas
    • Webinars
    • COVID-19 Event Tracker
    • podium march webinar logo lockup
      Sponsored Content Provided By Podium
      Webinar: Critical Touchpoints for Every Patient’s Journey — How Technology Plays an Important Role
      scp health logo lockup march 2021
      Sponsored Content Provided By SCP Health
      Webinar: COVID’s call to action — Reset for success in 2021
    • Women Leaders in Healthcare Conference
    • Social Determinants of Health Symposium
    • Healthcare Transformation Summit
    • Leadership Symposium
    • Virtual Briefings
      • - Hospital of the Future
      • - Mental Health
      • - Patient Safety & Quality
      • - Strategic Marketing
      • - Virtual Health
      • - Workplace of the Future
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Minority Leaders Gala
    • Top 25 Women Leaders Gala
  • Listen
    • Podcast - Next Up
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
    • Next Up Podcast: Educating patients on the COVID-19 vaccine with Tanya Andreadis
      Dr. Joseph Cacchione
      Next Up Podcast: Educating patients on the COVID-19 vaccine with Dr. Joseph Cacchione
      Dr. Karen DeSalvo
      Next Up Podcast: What to expect with telehealth and healthcare technology in the next four years
      Carter Dredge
      Next Up Podcast: Ready, set, innovate! Innovation and disruption in healthcare
    • Beyond the Byline: Insurers are betting on virtual-first plans as COVID-19 shifts care pathways
      Beyond the Byline: How residents' stories shape our coverage of the vaccination rollout in nursing homes
      Beyond the Byline: Regulators aim to boost value push with fraud and abuse law updates
      An older man wearing a mask receiving a vaccine.
      Beyond the Byline: Verifying information on the chaotic COVID-19 vaccine rollout
    • Outreach during COVID-19
      Leading intention promote diversity and inclusion
      Introducing Healthcare Insider Podcast
    • The Check Up: Dr. Marc Boom
      The Check Up: Dr. Marc Boom of Houston Methodist
      The Check Up: Dr. Imran Andrabi
      The Check Up: Dr. Imran Andrabi of ThedaCare
      The Check Up: Tanya Blackmon
      The Check Up: Tanya Blackmon of Novant Health
      The Check Up: Dr. Patrick Hwu
      The Check Up: Dr. Patrick Hwu of the Moffitt Cancer Center
    • ivana naeymi-rad one on one intelligent medical objects
      Video: Ivana Naeymi Rad of Intelligent Medical Objects
  • MORE +
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Government
April 05, 2017 01:00 AM

Thousands of brokers exit HealthCare.gov as plan commissions go unpaid

Virgil Dickson
  • Tweet
  • Share
  • Share
  • Email
  • More
    Print
    HealthCare.gov

    Each year since the launch of HealthCare.gov, insurance broker Craig Paulson faces a difficult question: Should he continue to sell individual market plans even though insurance companies increasingly refuse to pay commissions?

    If his Utah-based insurance brokerage firm, Altura Benefits, stops selling exchange plans, consumers may be left with lower quality coverage or none at all. In the past year, Aetna announced it would stop paying any commissions on the individual market in Utah. Molina Healthcare later announced that it wouldn't pay for commissions on special enrollment plans.

    “It's created a moral conflict,” Paulson said. “We want to do what's right for the client, but if you're not getting paid for your services, you can't remain in business.”

    Paulson isn't alone in his dilemma. More insurance companies around the country are refusing to pay brokers commissions on higher-tier exchange plans or special enrollment sales as the companies face financial losses on the federal marketplace, according to Ronnell Nolan, CEO of Health Agents for America, which represents independent insurance brokers.

    “It's the Wild West out here, and companies are doing what they can to survive,” Nolan said. “They're not paying commissions on platinum plans, and they are not paying them for special enrollment plans which cover some of the sickest patients.”

    That policy has led to an exodus of brokers from the federal marketplace, which could undermine enrollment efforts since brokers historically sign up at least 50% of exchange enrollees, according to Kevin Counihan, the former CEO of HealthCare.gov under President Barack Obama.

    Brokers help consumers navigate coverage options. Once they sign up, brokers tend to advocate for their customers if claims get denied. Between 2015 and 2017, there's been a nearly 35% drop in the number of registered brokers for HealthCare.gov, according to data from the CMS. The number dropped from more than 103,000 to just over 67,000.

    Before the Affordable Care Act, insurance companies paid brokers, on average, a 5% commission based on monthly premiums for plans sold on the individual market.

    Insurance companies increasingly are choosing to not pay that fee, or selectively are paying it for less expensive plans like bronze plans, which have high deductibles. The strategy is necessary for them to remain financially viable, insurance companies say.

    “Like any business, we encourage the sale of products that aren't as likely to lose money for the company,” said Mary Ann Tournoux, a senior vice president at Health Alliance Plan, which offers exchange coverage in Michigan.

    The number of individuals selecting bronze plans during open enrollment on the federal marketplace has jumped 6% between 2015 and 2017. During that same period, 47% fewer people chose more robust gold plans and 90% fewer consumers chose platinum plans, according to the CMS.

    Under the ACA, insurers must pay commissions for marketplace coverage if they also pay commissions for similar non-marketplace plans.

    Despite years of complaints from groups like HAFA and National Association of Health Underwriters, the CMS was unwilling to enforce commission payment rules for fear that it would discourage insurer participation in the federal marketplace, according to Nolan.

    Counihan had a different explanation for why the CMS wasn't more aggressive about ensuring broker commissions.

    “We didn't want to be overly prescriptive in telling private companies the details in how they are going to run their strategies,” Counihan said. “They're big boys that can figure that out for themselves.”

    The CMS stepped in after receiving reports of insurers paying commissions for lower tier plans and not higher level gold and platinum plans, in violation of federal law.

    The agency issued a guidance in December 2016 that instructed plans to be consistent in their commission-paying strategies across all metal plan levels.

    The policy is effective Jan. 1, 2018, giving plans time to include commissions in premiums, Counihan said.

    But brokers claim nothing has changed since the guidance came out, and they doubt it will have much of an impact because, they say, it is vague its enforcement.

    The CMS policy also doesn't address whether insurers must pay commissions on special enrollment plans. Major plans like Anthem announced last year that they wouldn't pay commissions for new individual members who enroll in any ACA-compliant plans on or off the exchange.

    “We believe our broker commission rates comply with the applicable laws and regulations,” said Leslie Porras, a spokeswoman for Anthem.

    Other plans defended their reasons for selectively paying commissions.

    “Because of widespread concerns regarding the eligibility verification of many members who enter the market through special enrollment, Highmark does not pay broker commissions on any SEP enrollment,” said Aaron Billger, a spokesman for Pennsylvania-based Highmark.

    The CMS is also teaming up with HAFA to investigate the prevalence of unpaid broker commissions. The agency has asked HAFA to survey its members to determine the scope of the issue and its implications.

    The National Association of Health Underwriters are also working with the CMS on a new rulemaking. The group met with HHS Secretary Tom Price last month to discuss whether broker commissions could be carved out before a plan calculates its compliance with the ACA's medical loss ratio.

    The ACA requires plans spend at least 80% of their premium income on healthcare claims and quality improvement, leaving the remaining 20% for administration, marketing and profit. Insurance companies have told brokers that the breakdown makes it hard to pay commissions.

    Price seemed interested in the idea and talks are ongoing, according to Marcy Buckner, NAHU's vice president of government affairs.

    “What we are arguing is that without compensation for brokers, there's going to be a limiting of access to coverage for consumers,” Buckner said.

    Some plans are paying commissions because they see brokers as a critical component in consumer education.

    “The worst thing that can happen is that a person picks a plan that's not the right fit and they end up with more out of pocket costs than anticipated and cancel their coverage,” said Rick Notter, director of individual business for Blue Cross and Blue Shield of Michigan.

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    Feds shouldn't lose sight of drug misuse epidemic, GAO says
    Feds shouldn't lose sight of drug misuse epidemic, GAO says
    States easing virus restrictions despite experts' warnings
    States easing virus restrictions despite experts' warnings
    Sponsored Content
    Get Free Newsletters

    Sign up for free enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today

    The weekly magazine, websites, research and databases provide a powerful and all-encompassing industry presence. We help you make informed business decisions and lead your organizations to success.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS
    • Instagram

    Stay Connected

    Join the conversation with Modern Healthcare through our social media pages

    MDHC_Logotype_white
    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2021. Crain Communications, Inc. All Rights Reserved.
    • News
      • This Week's News
      • COVID-19
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition
    • Insights
      • ACA 10 Years After
      • Best Practices
      • Special Reports
      • Innovations
    • Transformation
      • Patients
      • Operations
      • Care Delivery
      • Payment
    • Data/Lists
      • Rankings/Lists
      • Interactive Databases
      • Data Points
    • Op-Ed
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Awards
      • Award Programs
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top 25 Innovators
        • Minorities in Healthcare
          • - Luminaries
          • - Top 25 Minority Leaders
          • - Minorities to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Nominate
      • Previous Award Programs
        • Excellence in Nursing Awards
        • Design Awards
        • Top 25 COOs in Healthcare
      • Other Award Programs
        • 100 Top Hospitals
        • ACHE Awards
    • Events
      • Conferences
        • Women Leaders in Healthcare Conference
        • Social Determinants of Health Symposium
        • Healthcare Transformation Summit
        • Leadership Symposium
        • Virtual Briefings
          • - Hospital of the Future
          • - Mental Health
          • - Patient Safety & Quality
          • - Strategic Marketing
          • - Virtual Health
          • - Workplace of the Future
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Minority Leaders Gala
        • Top 25 Women Leaders Gala
      • Webinars
      • COVID-19 Event Tracker
    • Listen
      • Podcast - Next Up
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • MORE +
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing