Health agents must start now to keep clients from losing ACA coverage

Health insurance agents who work in the Affordable Care Act market need to begin working with clients now to help them prepare for new regulations that will impact their eligibility for coverage.

The “One Big Beautiful Bill” along with new regulations from the Centers for Medicare and Medicaid Services will create some challenges for consumers to remain enrolled in ACA coverage. At a recent webinar organized by ACA Way, health agents were given some advice on how to keep their clients from being tossed off the ACA rolls.

Open enrollment for ACA coverage begins Nov. 1 and runs through Jan. 15.

Cathy Grason, associate general counsel at Oscar Health, gave a rundown of some of the changes that will impact ACA coverage.

• Market integrity rules. Pauses the special enrollment period for those who earn less than 150% of the federal poverty level. That pause takes effect Aug. 25 and will go on through 2026.
• Zero dollar rule. ACA enrollees who were eligible to receive coverage for $0 premium cannot auto-renew; they must verify their eligibility or else pay a $5 premium.
• Income eligibility checks. ACA enrollees who are over 100% of FPL must attest to their eligibility to receive coverage.
• File your taxes. ACA enrollees must file their federal income tax returns to be eligible for premium tax credits.
• No more DACA. Those who are in the U.S. under Deferred Action for Childhood Arrivals – also known as “Dreamers” – are no longer eligible for ACA coverage and must obtain health insurance elsewhere.

 Health agents must remain engaged with clients

The common theme of these regulations is that agents must remain engaged with clients, said Ross Baker, senior agency account manager at HealthSherpa.

“We need to do brand marketing,” he said. “We need to make sure that if we request a document or request an action from our clients that they’re going to pick up the phone or answer our email. We need to make sure people know that you’re their broker, you’re where to go when they need health insurance help.”

Baker said the new rules make it especially important for agents to reach out to those clients who would be subject to the $5 premium charge. “It’s not just keeping clients engaged but pushing for doing active renewals,” he said. “If you want to avoid them paying that $5 premium change, you‘ll have to do an active renewal and make sure they’re verifying their income.”

Eliminating fraud, waste and abuse

Much of the rationale behind regulations governing the ACA and Medicaid is to eliminate fraud, waste and abuse. Agents want to eliminate fraud, waste and abuse as well but “what we can do is make sure that the right levers are pulled at the right time that has an impact that doesn’t expose our communities,” said Jessica Brooks-Woods, CEO of the National Association of Benefits and Insurance Professionals.

She noted that more than 80% of those who obtain coverage in the ACA marketplace are assisted by agents.

Brooks-Woods urged agents to look at the demographics of their client list and “try to get ahead of who is likely to be most vulnerable and communicate with them, help them prepare for open enrollment.”

Tony Feijoo, founder and CEO of New Health Partners, said he is concerned about ACA enrollees with income of more than 400% of FPL and who are between the ages of 51 and 62. That cohort represents more than 50% of ACA enrollments.

“I am concerned that this group is simply not going to be able to afford health insurance. They’ll see their premiums rise as much as 75%.”

An opportunity for the industry to unite

Feijoo said the changes to the ACA “are fuel for us as an industry to unite and coalesce. We have a voice as an industry but the much more powerful voice comes from the consumers. We must engage the consumers to have their voices heard.”

He called on agents to talk about the implications of the bill with their lawmakers, but to focus on telling the stories of clients who will be impacted.

“Don’t just call your local representative and say, ‘This bill sucks.’  You must have the human impact behind ‘this bill sucks.’ How does that $5 premium hurt individuals who don’t have bank accounts? What happens to the single mom who works two jobs and now loses Medicaid over a document? What will happen to the 55-year-old couple who will see their premium go up by 75%? That has more impact on legislative bodies than saying this bill sucks.”

Feijoo urged agents to begin now to start calling clients who might be in danger of losing ACA coverage. “And some of the carriers also are helping us by identifying our at-risk customers so we can provide them with the assistance, the documentation and getting ready for open enrollment.”

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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].