With no broker fees, will Obamacare customers get enough shopping help?

This is a picture of Access Health's New Britain store

Arielle Levin Becker / The CT Mirror

Access Health’s New Britain store

Shopping for health insurance isn’t easy for most people, but for Branden Weaver, the stakes are especially high: His two young sons are on the autism spectrum, and he and his wife are determined to ensure they have a health plan that covers the practitioners who treat them.

But the first time they tried signing up for coverage through the state’s health insurance exchange, Access Health CT, they ended up in Medicaid, which didn’t cover one of their older son’s providers. Weaver tried to sign his son up for a private insurance plan that did, but even with his information technology background, he found it difficult. So he turned to an insurance broker.

“He was able to help right away and get things situated,” said Weaver, a stay-at-home dad in Southington.

Weaver has gone back to his broker for issues that have come up since then – things he dreads handling on his own. But for him and thousands of other Obamacare customers who have their own brokers, getting their help probably won’t be an option much longer.

While insurance companies have traditionally paid brokers a monthly commission for each policy they sell, insurers are discontinuing those fees for 2017 plans sold through Access Health. That means that brokers who continue working with their exchange clients probably would be doing so without pay.

The change in broker availability comes at a time of significant flux for the exchange. About half of Access Health’s close to 100,000 customers will need to change plans during the open enrollment period that begins Nov. 1, said Jim Wadleigh, the exchange’s CEO. Some are covered by companies that won’t sell exchange policies in 2017 – HealthyCT and UnitedHealthcare – while others have plans that are being discontinued.

And many have relied on brokers in the past. This year, 40 percent of exchange policies were sold through agents or brokers.

To help those who want advice, Access Health plans to have approximately 20 brokers working through its call center or in storefronts in New Britain and New Haven. The brokers will be contracted through the call center vendor and paid a salary; the total cost is expected to be around $1 million, some of which will come from reductions in Access Health’s advertising.

“That obviously isn’t going to be free,” Wadleigh said. “We think it’s about the best that we can do in the short period of time.”

But some have questioned whether it will be adequate.

“I’m anticipating that the consumers are going to be extremely upset and it’s going to be a very tough open enrollment period for Access Health CT,” said Tim Tracy Jr., a Fairfield insurance broker and president of the Connecticut Chapter of the National Association of Health Underwriters. “You’re going to be taking all these people that have worked with their brokers for multiple years, [are] comfortable with brokers, brokers [who] are local. Now you’re saying sorry, you’re going to have to call the 800 number and deal with whoever we’ve hired and is on the phone.”

Will it be enough?

The exchanges created by the federal health law were intended to make it easier for people to comparison-shop for health plans. But Jesse McDonald, a Milford broker, said that without digging beyond the initial online results page, shoppers could pick a plan that costs them more for care or doesn’t cover their doctor or medication.

“The consumer can get caught choosing the wrong plan,” McDonald said.

Besides helping people pick plans, brokers help clients submit the documents needed to verify their eligibility. McDonald said if brokers aren’t available, it probably will mean more calls to Access Health.

The change in the broker situation also concerns Deb Polun, director of government affairs and media relations at the Community Health Center Association of Connecticut.

Health centers have staffers who are trained to help people sign up for coverage, but they’re not allowed to advise people on plan selection – nor do they have the training for it, Polun said. In the past, they gave out lists of brokers to call for help choosing.

Without a broker, she said, “It would be like a doctor saying to you, ‘Here’s seven prescription drugs. Just pick the one you want.’”

She thinks the 20 or so brokers who will be available through Access Health probably won’t be enough to meet the demand.

Wadleigh said he hopes they will be able to handle the volume.

“My gut tells me that if everyone calls us in the last two days, we won’t be able to handle all those calls,” he said. “So we will continue to push and encourage everyone to call and enroll prior to [the last minute].”

He added that the exchange intends to work with the insurance companies to reach out to customers who need to change plans to try to get them signed up before the Dec. 15 deadline for coverage that starts Jan. 1. Others can be automatically re-enrolled.

“In a perfect world, we’re hoping that we can adapt and adjust, and if we don’t, we’ll re-evaluate after open enrollment and work with the carriers and the brokers to see what we can come up with,” Wadleigh said.

Why no commissions?

Anthem cited price as a factor in its decision to stop paying commissions for exchange plans. Commissions come out of the premiums customers pay.

“In evaluating these changes, we believe they are necessary to create long-term sustainable pricing while providing customers with health care that remains affordable,” the company said in a statement.

Anthem spokeswoman Sarah Yeager said the company also concluded that a low percentage of individual business was generated by brokers compared to other resources available through the exchange. And she noted that the exchange has tools that allow people to shop on their own.

Access Health CT CEO James Wadleigh

Access Health CT CEO James Wadleigh

ConnectiCare acknowledged that it will not pay commissions for exchange products, but did not explain why.

Both Anthem and ConnectiCare will continue paying commissions for plans sold outside the exchange.

Brokers said it’s not clear if there are alternative ways to continue serving exchange clients, since there are restrictions on charging clients money.

According to the Connecticut Insurance Department, licensed insurance agents and brokers can’t charge a fee to people buying health insurance that qualifies for subsidies on the exchange. Those licensed as certified insurance consultants can charge a fee for advice, counsel or opinion, but they can’t benefit from selling an insurance policy.

Even if they could charge consulting fees to exchange customers, brokers said that’s unlikely to be a widespread option since many people buying coverage struggle to afford even discounted premiums.

John Calkins, a Watertown insurance agent and legislative chairman for the underwriters’ association, predicted that commissions could become a legislative issue next year. He noted that in California, commissions are required for plans sold through the exchange.

“Poor people are going to be discriminated against because they can’t get a licensed professional agent,” Calkins said. “We want to help our clients. We want to continue to help the 40 percent we enroll, but unless the state of Connecticut’s going to give me a break on taxes or a break on electricity and payroll and everything else, how can I afford to do this?”

McDonald has about 200 to 250 clients who buy plans through the exchange, about one-third of his individual-market business. This year’s commissions for most plans are $16 per month.

“I have to try to find a way to guide them as best I can given the fact that it would be pro bono work on a mass scale,” he said. “I don’t know realistically if it’s doable, because anytime you’re in business, if let’s say a third of your revenue stream is gone, you have to find new revenue streams.”