HAFA Goes To DC To Discuss Agent Compensation, No Surprises Act

By Susan Rupe

A health insurance agents’ association went to Washington recently as part of its ongoing fight for its members’ ability to serve their clients

Health Agents for America returned recently from its annual visit to Washington, where they discussed concerns over agent commissions and other factors that they say are impairing agents’ ability to do their jobs.

Members have an ongoing concern with many carriers not paying commissions to agents for new enrollments or enrollments during special enrollment periods under the Affordable Care Act.

The Centers for Medicare & Medicaid Services issued a statement in 2016 regarding broker compensation and discriminatory marketing practices. Under a CMS rule, “an insurer … cannot employ marketing practices or benefits designs that will have the effect of discouraging the enrollment of individuals with significant health needs in health insurance coverage …” CMS determined paying commissions is a marketing practice, HAFA said, and many insurers responded by not paying commissions for new or special enrollments.

“This has a clear and undeniable adverse impact on the poor, vulnerable and often minority communities who need help the most but are unable to pay for the services,” HAFA said in a statement shared with lawmakers. “This leaves individuals without advocacy when issues arise.”

Navigator transparency was one issue discussed with Congress, said Ronnell Nolan, HAFA’s president and CEO, told InsuranceNewsNet. Agents are competing with navigators to enroll consumers in health insurance through the ACA exchanges.

Navigators received record high funding for the more recent open enrollment period, with CMS announcing $80 million in funding for the navigator program for the 2022 plan year. That was significantly higher than the $10 million in annual funding that the navigators received during the 2018-2020 period and a jump from the $63 million in funding that was awarded in the final year of the Obama administration.

Nolan said HAFA requested the Government Accountability Office report on where the navigator funding was spent.

“Navigators are getting thousands per policy while agents are getting dollars and cents,” she said. “We want to find out where that money is going.”

The No Surprises Act, which establishes new federal protections against surprise medical bills, took effect this year. Nolan said HAFA members expressed their support for the law, which addresses medical bills that arise when insured consumers inadvertently receive care from out-of-network hospitals, doctors or other providers they did not choose.

The law will protect consumers from surprise medical bills by requiring private health plans to cover these out-of-network claims and apply in-network cost sharing. In addition, the law prohibits doctors, hospitals and other covered providers from billing patients more than in-network cost sharing amount for surprise medical bills.

“We told the members of Congress we met with that we don’t want our members’ clients to be hurt, whatever the bill looks like,” Nolan said.

Commission transparency has been a major issue for health insurance agents.

The Consolidated Appropriations Act of 2021 requires brokers and consultants who work in the health benefits field to disclose compensation from sources such as insurance carriers, including commissions, fees, and non-cash compensation. The new regulations require disclosure of direct and indirect payments to brokers that equal $1,000 or more, and disclosure of non-cash compensation that equals $250 or more.

Nolan said she met with CMS and Department of Labor officials to get a better idea of what the disclosure regulations will mean to HAFA members.

“We’re looking for guidance,” she said. “CMS said insurance companies can disclose agent compensation but some companies say it’s the agent’s responsibility. CMS needs to give some final rules on this. We believe the companies should disclose commissions.”

Additional CMS proposed rules impact agents’ reporting of income for those buying health insurance on the ACA exchanges, Nolan said.

“CMS says agents need to enter the correct income for someone buying health insurance. But how many are actually doing it? Three? Three hundred? These additional rules are insinuating agents are doing it wrong without having any evidence. You have to ask your client what they estimate their income will be in the coming year. But what if they get a bonus or a contract they didn’t expect? What if the client didn’t update their income? It’s not the agent’s fault.”

Susan Rupe is managing editor for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected]. Follow her on Twitter @INNsusan.