Consumers can skip HealthCare.gov for 2018 insurance coverage
The Trump administration took steps last week that could make it easier for consumers to get coverage under the Affordable Care Act, albeit at the potential demise of the federal insurance exchange.
The CMS said it would allow people to bypass HealthCare.gov in order to buy an ACA-approved plan for 2018. Individuals will be able to get coverage directly from a broker or an insurer’s website instead of having to go through the federal marketplace, the CMS announced. That news came just two days after small businesses were given permission to skip the federal marketplace as well.
Currently, consumers working with a broker must go to HealthCare.gov to determine eligibility for subsidies or tax credits. Eventually, the applicant goes back to the broker’s or insurer’s website to finalize their coverage.
When open enrollment kicks off Nov. 1, applicants will be able to complete the entire process, including checking on eligibility for subsidies and tax credits, on a broker or insurance company website.
Brokers historically sign up at least 50% of exchange enrollees.
The other policy announced last week allows companies with 50 or fewer employees to also work directly with brokers to offer coverage to workers. Small businesses will still have to use the Small Business Health Options Program marketplace, known as SHOP, to determine eligibility, however. There’s some speculation that the move is an attempt to reduce federal oversight of SHOP given the low enrollment numbers. As of January 2017, just 230,000 people have used the program.
Depending on how the policy for individuals is received, the Trump administration may seek other ways to exempt people from using the federal marketplace. “If this works very well, there will be proposals to shrink or eliminate HealthCare.gov,” predicted Mark Pauly, a health economist at the Wharton School of the University of Pennsylvania.
The Trump administration says the goal is to help create stability in the health insurance market. “It is common sense to make it as simple and easy as possible for consumers to shop for and access health coverage,” CMS Administrator Seema Ver- ma said in a statement. “It is time to get the federal government out of the way and give patients the best tools to make their own healthcare decisions.”
Broadening distribution channels for consumers to gain coverage makes sense, said Kevin Counihan, CEO of HealthCare.gov under President Barack Obama. He cautioned that the CMS should certify that third-party vendors have the necessary administrative capabilities.
The Obama administration had raised the idea for a direct enrollment in proposed rulemaking, but it was never finalized. Serious concerns had been raised about consumers having to provide personal financial information to third parties, which creates more opportunities for that information to be vulnerable,, said Larry Levitt, a senior vice president at the Kaiser Family Foundation.