Each year since the launch of HealthCare.gov, Salt Lake City insurance broker Craig Paulson has faced a difficult question: Should he continue to sell individual-market plans even though insurers increasingly refuse to pay him commissions?
In the past year, Aetna announced it would stop paying commissions for new individual members who enroll in any Affordable Care Act-compliant plans. Molina Healthcare later announced that it wouldn't pay commissions for sign-ups during special enrollment periods outside the annual open enrollment.
At least partly as a result of such moves by insurers, there was a nearly 35% drop in the number of registered brokers for HealthCare.gov between 2015 and 2017, according to CMS data. The number dropped from more than 103,000 to just over 67,000.
Paulson worries that if his brokerage firm, Altura Benefits, stops selling exchange plans, his customers may be left with lower quality coverage or none at all. “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.”
As insurers face losses in the ACA's individual market, more insurers around the country are refusing to pay broker commissions, particularly on higher-tier exchange plans or special enrollment period sales, said Ronnell Nolan, CEO of Health Agents for America, which represents independent brokers.
She and other experts say insurers are doing this to discourage enrollment of people needing costly medical services, who tend to select platinum or gold plans with low cost-sharing or who sign up through special enrollment periods.