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Covered California Q&A

Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.


Exchange Enrollment Scenarios

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Question: How do you see the agent completing an enrollment in the Exchange? Will we be able to enroll subsidized members? What about our existing individual members?

Answer: It remains to be seen how the Exchange guides enrollments from the carrier and agent channels. The best I can do at this point is provide some likely scenarios.

  • Only a contracted carrier or the Exchange itself - acting as administrator for the carrier - can complete an enrollment. Agents and Navigators involved in outreach, education, and pre-screening will complete an application for enrollment and submit it to the Exchange.
  • Agents and Navigators could pre-screen individual health insurance applicants for eligibility for subsidized coverage in the Exchange or Medical, and transmit pre-populated applications and a warm hand-off to Exchange staff to complete enrollment.
  • Contracting carriers could partner with the Exchange in enrolling both current members who are subsidy-eligible, and new subsidy-eligible members that the carrier identifies as part of the its marketing efforts. This is a cost-effective means to provide a sizable portion of the Exchange’s projected first year enrollment.

The process we envision would be similar to the current method submitting an online application to a carrier for underwriting, Of course, post reform there will be no medical underwriting, but financial underwriting in its place.

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