The Affordable Care Act (ACA) stipulates that the state Exchanges provide an individual with options to choose any qualified health plan (QHP). Covered California extends this requirement to participating health plans. The carriers don’t like it. Carriers spend a lot of money in direct marketing to attract customers to their brand. They don’t like supporting their competitors. Why should Anthem drive business to Covered California only to have their prospective customer enroll in a Kaiser plan?
Assisters are held to a similar standard. It does make sense for Navigators, who are compensated by Covered California, to focus on providing individuals with all of their options. However, requiring Agents to provide information on QHPs for which they may not be compensated would reduce their incentive to invest their time and money in marketing and thereby undermine Covered California’s goal of maximizing enrollment.
I support the requirement to ensure any assister, including an agent who is paid by a health plan issuer, to inform consumers that other enrollment options exist. However, I am concerned that stringent requirements that ensure agents to fully represent all QHPs available will likely minimize the QHP agent channel.
Additionally, I am concerned that Covered California expects every assister to be an expert in every available QHP. Based on my experience in the market today, this is unlikely, particularly given the breadth of products that an enrollee could be eligible for, both in and out of the Exchange.