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Health Care Reform:

Health Insurance & Affordable Care Act

Administration Tests Fixes That Would Allow Insurers, Brokers To Enroll More Consumers


Insurers can already directly enroll customers who want a health plan and don’t qualify for a subsidy, which is available for people who earn up to 400 percent of the federal poverty level, or about $46,000 for an individual.

Even though the health law allows direct enrollment, some advocates fear that consumers won't see the full choice of plans available if they shop on a single insurer’s website, rather than seeing all their choices by going to, a state-based marketplace or an online brokerage. Online brokerages are required to show shoppers all options available in a region, but insurers are not.

The biggest challenge getting direct enrollment functioning has been linking insurers and brokers with the information they need to determine consumers’ eligibility for subsidies, including their citizenship status and income verification.

The way that is supposed to work in the 36 states served by the federal website is that consumers who start out on an insurer’s or online broker’s website are automatically transferred to to determine if they qualify for a subsidy, then transferred back once that information is confirmed. Often, that transfer has gotten caught up in the error messages and other difficulties that have plagued the federal website since it opened Oct. 1.

“What they need is a way … to get a subsidy eligibility determination without having to go through the whole rigmarole,” said Dan Mendelson, CEO of Avalere Health, a Washington D.C.-based consulting firm.

Administration officials said last week that steady improvements are being made to, and that waiting times and error messages are well below where they were just two weeks ago. They said they also have made progress in fixing systems designed to let insurers directly enroll subsidy-eligible customers.

While those fixes are still being tested, some industry experts say a better solution might be to allow insurers and brokers to directly connect with the “federal data hub,” the portal through which subsidy calculations are made after applicants’ information is cross checked with several government agencies, including the IRS and Homeland Security.

Sun, Nov 24 2013

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