The Inexpensive Care Act (ACA) expanded reasonably priced well being protection choices within the U.S., serving to to scale back the variety of uninsured people. Even so, KFF has discovered that most individuals who stay uninsured are nonetheless eligible for protection and monetary help by way of the Market or Medicaid. Many shoppers – together with most uninsured – have restricted consciousness of reasonably priced protection choices accessible to them underneath the ACA. And the steps individuals should take to get and maintain protection can generally be advanced. Accordingly, the ACA required federal and state Marketplaces to ascertain and spend money on client help to conduct outreach and public training and to assist join individuals to reasonably priced protection.
KFF performed a nationwide, on-line survey of Market Assister Packages and brokers in 2022. To construct the pattern for the survey, contact info for Assister Packages and brokers was collected from State Marketplaces (SBM), the Heart on Medicare and Medicaid Providers (CMS) which administers the Federal Market (FFM), and the Well being Sources and Providers Administration (HRSA) which oversees enrollment help by Federally Certified Well being Clinics (FQHCs). A complete of three,496 Assister Packages have been invited by e mail to take part within the survey, and 258 Packages responded and have been included (for a response price of seven.4%). We additionally contacted 68,705 brokers licensed to promote Market protection and 1,424 responded and have been included (for a response price of two.1%). Further description of survey strategies is included within the Topline accompanying this report.
Our survey requested Assister Program administrators and brokers concerning the assist they supplied shoppers earlier than, throughout and after the 2022 Open Enrollment Interval, causes individuals sought assist, elements affecting the enrollment course of, and different points. Key findings embrace:
Assister Packages and brokers report that the necessity for client help is excessive amongst individuals they serve. Overwhelmingly, Assister Packages (76%) and brokers (69%) stated most or almost the entire shoppers they helped throughout this ninth ACA Open Enrollment lacked confidence to use on their very own; about two-thirds of Assister Packages (64%) and brokers (66%) stated most to just about all of the individuals they helped had restricted understanding of ACA necessities and advantages. Most Assister Packages and brokers (54% every) additionally stated the vast majority of shoppers they helped had problem understanding fundamental medical health insurance phrases and ideas. Shoppers additionally wanted assist answering questions on their family earnings and composition, and assist evaluating a lot of plan selections. Some shoppers current with advanced circumstances or want language help – challenges that Assister Packages say require extra assets and technical assist than is accessible from the Market.
Most Assister Packages and brokers stated the common time wanted to assist individuals newly making use of by way of the Market continued to be between 1 and a pair of hours; for shoppers returning to resume or change protection, it was as much as 1 hour. That is much like findings in earlier KFF surveys in 2016, 2015, and 2014.
Client consciousness about Market subsidies and guidelines continues to be restricted. Practically all Assister Packages (89%) and brokers (80%) this 12 months additionally helped shoppers final 12 months to enroll in protection or replace subsidies through the 2021 COVID-19 enrollment interval. Newly enhanced Market subsidies turned efficient through the 2021 COVID enrollment interval, although our respondents noticed that client consciousness concerning the enhanced subsidies was low; 71% of Assister Packages and 75% of brokers stated most to just about all shoppers they helped through the 2021 COVID enrollment interval have been unaware of the brand new, improved subsidies once they first got here in for assist.
Assister Packages report that some shoppers eligible for Medicaid expertise delays in getting a last eligibility willpower. In 17 states the Market determines Medicaid eligibility, whereas in the remainder, the Market transfers recordsdata to Medicaid for a last eligibility willpower, which may trigger delays. Consequently, Assister Packages report the time it takes for shoppers to obtain an eligibility willpower varies broadly. Forty-three % of Packages stated eligibility determinations have been decided in actual time or Medicaid enrollment was computerized, whereas an equal share of Packages stated the method takes longer – 11% stated Medicaid determinations have been supplied in as much as 7 days, 21% stated determinations took from 8 days to 1 month, and 11% stated it took longer than a month.
Assist from Brokers and Assister Packages is analogous in lots of respects however not interchangeable. We additionally surveyed brokers licensed by the Market to promote certified well being plans. The kind of assist brokers reported offering and other people they reported serving to resembled that of Assister Packages, although there have been necessary variations, seemingly reflecting variations within the purchasers served. Specifically, brokers – who depend on commissions – have been far much less seemingly to assist shoppers join Medicaid or CHIP (39% of brokers vs 88% of Assister Packages) and much much less prone to conduct outreach actions (27% vs 62% of Assister Packages). In comparison with Assisters, Brokers who responded to the survey reported {that a} smaller share of the shoppers they helped have been Hispanic, wanted language help or assist with immigration-related issues, or have been uninsured.
Brokers depend on personal web pages over Market websites. Most brokers (72%) surveyed report utilizing personal web sites as a substitute of the Market to enroll shoppers in QHPs no less than among the time. In most states brokers can use so-called direct enrollment (DE) websites, for instance hosted by insurance coverage firms, the place shoppers can join Market QHPs, although shoppers typically are re-directed to the Market website if in addition they want subsidies. The federal authorities additionally promotes use of Enhanced Direct Enrollment (EDE) websites – solely accessible in federal market states – the place shoppers can apply for each QHPs and market subsidies with out ever visiting HealthCare.gov. A majority of brokers in federal market states (55%) stated they by no means provoke QHP functions on HealthCare.gov. When requested why they like these alternate enrollment channels, many brokers cited technological options which HealthCare.gov doesn’t provide, resembling dashboards that allow them to extra simply observe consumer accounts and talk with purchasers. Sixty % of brokers surveyed who use personal websites stated they might use the Market web site extra typically if provided related performance.
Brokers additionally proceed to promote non-ACA-compliant insurance policies. Most brokers (75%) stated in addition they offered non-ACA-compliant insurance policies – resembling short-term plans — throughout Open Enrollment instead or complement to QHPs, although the amount of those gross sales was decrease in comparison with QHP gross sales. For instance, most brokers (54%) stated they offered greater than 50 QHPs through the 2022 Open Enrollment interval, whereas most who additionally offered non-ACA-compliant insurance policies (67%) stated they offered 10 or fewer of those insurance policies.
Most Assister Packages count on to play a job serving to shoppers by way of the general public well being emergency (PHE) unwinding. It’s anticipated that the COVID-19 Public Well being Emergency could finish someday in 2023, at which level, state Medicaid companies will resume eligibility redeterminations and can disenroll people who find themselves not eligible or who’re unable to finish the renewal course of even when they continue to be eligible. Consequently, between 5 and 14 million individuals are estimated to lose Medicaid protection. Many who lose Medicaid could also be eligible to purchase sponsored QHPs, if they’ll navigate that transition. About half of Assister Packages (53%) stated they’ve good working relationships with their state Medicaid company and almost 6 in 10 stated they’ve contacted Medicaid to learn the way they may also help educate shoppers about the necessity to renew their protection. Half of all Assister Packages reported they’re planning outreach actions to coach the general public concerning the PHE unwinding and most (58%) stated they’ll attempt to re-contact shoppers whom they helped apply for Medicaid protection prior to now two years to gather up to date contact info.