Health Insurance Shopping
Health insurance navigators aren’t the only ones giving advice about health insurance. Insurer-affiliated agents and brokers are some of the first people a consumer might find when searching for enrollment support online. This is affirmed by a recent study by the Georgetown University Center on Health Insurance Reforms (CHIR) that looked at the challenges people are facing in this current insurance marketplace. They found that agents and brokers are regularly misleading consumers about marketplace coverage options and trying to divert consumers to limited benefit plans. Recommended plans are more likely to lack the consumer protections provided by the Affordable Care Act.
With the expiration of enhanced premium tax credits (ePTCs), premium costs have forced many people to reconsider the cost of comprehensive coverage. According to KFF, marketplace enrollment has dropped by 13% since ePTCs expired. By 2027, the median premium may increase by 15%. The average ACA deductible has also increased by over $1,000 in the last year as people choose lower-premium plans. Affordable care is especially a concern for disabled people who want the assurance that needed care will be included in their insurance coverage. Without quality options, some people with disabilities may be starting to consider a variety of non-ACA compliant plans that may be cheaper in the short-term but will not provide the comprehensive coverage many people with disabilities need. If people search for support online, they will be pushed towards private health plans through a series of known steps:
- A simple Google search will direct potential enrollees to a “lead generator” website. These pages may mislead people by appearing to be government affiliate resources.
- A user will fill out a form with basic contact information and demographics in order to get an insurance quote.
- This information is sold to licensed health insurance agents who may be working with a specific agency. Agents are incentivized to sell private plans and receive a commission for every person they enroll.
- Potential enrollees will have to make sense of the recommendations they receive, and may not be aware of the full limitations of the options presented to them as preferred alternatives to ACA Marketplace plans.
For the people with disabilities you’re supporting through the healthcare enrollment process, be aware that they may be receiving some common talking points online as they prepare to select a plan. They might be told that ACA plans are only for sick consumers. They are most likely to be targeted for non-ACA plans if they are outside the range of premium tax credit eligibility (400% FPL). They are also likely to be under-informed about the products positioned as an alternative to the ACA Marketplace plans. You can encourage them to think critically about the options they’re viewing online. Ask:
- Does the plan cover pre-existing conditions?
- Do you anticipate needing regular medical appointments?
- Do you use assistive devices, and how often do they need replaced?
- Do you take a regular prescription medication?
- Do you have providers and services that you need covered on your plan?
- What kind of specialty care do you need? (Inquire about specialties like mental health, maternity care, and substance use services)
Despite the lower upfront cost of “junk plans”, there are fewer regulations in place to ensure that they offer a comprehensive suite of services and care. Consumers should know that agents and brokers are not required to provide unbiased information on all of the coverage options available, especially ACA Marketplace plans.
Resource Alert
KFF covers the legacy of the Affordable Care Act in this new video: Has the ACA lived up to its promise?
The NDNRC Newsletter is published biweekly through the summer. Archives of our weekly updates are available on the NDNRC website. This newsletter is supported by the American Association on Health and Disability (AAHD). Sign up to become an AAHD member today to support ongoing projects like this.