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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 to Facilitate Agent Appointments?

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Question: A recent news release from the DOI quotes Insurance Commissioner Jones saying: “The license approval for Covered California also provides a more efficient way for licensed agents to help consumers and businesses purchase health insurance through the Exchange, by allowing the agents to affiliate with the Exchange as opposed to obtaining appointments from each carrier selling health insurance products through the Exchange.” That seems so say that agents don’t have to worry about getting appointed with some of these lesser known carriers. Can you confirm?

Answer: Unfortunately I can’t confirm your assumption. I believe the Commissioner was referring to the SHOP exchange in the news release from which you quoted. In the SHOP, the Exchange pays the agent directly, so it stands to reason that being appointed with them is all you need. It would be tremendously helpful if the exchange provided a single path to appointments with all carriers in the individual Exchange as well. In fact, I’m pretty sure they said they would do so, but it was some time ago and I haven’t heard anything since.

7 Comments

That’s correct. Only in the SHOP exchange will Covered California act as our “agency” and pay us commissions for small group plans purchased through the exchange. All other individual and large group business requires an individual appointment with each carrier.

That is disappointing. I was hoping, at the least, that it would not be necessary to get separate appointments with the SHOP carriers that also market individual plans on the Exchange.

It became clear to me at the Covered California board meeting this week, that the Exchange will not facilitate agent appointments with carriers in the individual exchange.

Kathy …

Apparently you are not getting the kind of assistance you should be. I assume you are under age 65. If you are a Medicare beneficiary, you should have a Part D Prescription Drug Plan, too.

If you are enrolled in both Medicare Part A and Part B, you are eligible to enroll in a Medicare Advantage-Prescription Drug plan (MA-PD) — open enrollment begins October 15. That alone should reduce some of your out-of-pocket costs. You still have to pay the Part B monthly premium.

Have you been evaluated for Medi-Cal assistance? As a “Medi-Medi” beneficiary, you are eligible for a Medicare Advantage Special Needs Plan, which could eliminate almost (but not) all of your out of pocket costs. At the very least, with a Part D PDP (or MA-PD plan) you should be eligible for “Extra Help” with your prescription medication costs.

As a licensed Life & Disability Insurance Analyst, I can assist you with determining some of your eligibilities and direct you to the appropriate agencies for further assistance. Click on my name above and you’ll find my website and contact information.

My question concerns the best option as I am permanent disability,I have Medicare and Anthem advantage plan PPO . I need advice re best plan as I am currently responsible for 80 percent on inpt.hospitalization and medication is quite expensive depending on the tier and whether generic is available.I am not sure how to proceed ,is it best to utilize Medicare as primary and Anthem. As secondary to minimize costs,deductible,medication out of pocket etc.as I am receiving SSDI although costs seem so high on a fixed income.Any thoughts or suggestions would be appreciated. Thank you,Kathy Jeanmarie

Thank you for the answer and comment. I hope to see a final determination on this matter soon!

At Certified Insurance Agent training, this subject was discussed in private with the So.Cal director of the SHOP. Covered California, as of that date (Sept 6), was only doing this in the SHOP exchange. It will act as an IMO (or in some respects more like the insurer), with only certified insurance agents appointed by Covered California. Covered California will pay commissions to the agents, based on a standard formula, and the actual insurers selected by employees through the SHOP compensating Covered California.

It would certainly be easier if Covered California could do the same in the individual market, but that won’t happen in 2014. Things could change in 2015, but I’m not going to hold my breath.

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