“It’s so complex and complicated that you’ve got to deal with an agent or a person who really understands all the little dos and don’ts in the program,” said Floyd Rogers with Haywood Insurance in Waynesville.
Agent vs. navigator
Certified navigators offer free services to Western North Carolina residents to help them sign up for a health plan through the ACA online marketplace website. They are available through Mountain Projects or through hospitals.
Insurance agents can also help sign people up through the online exchange while explaining the details of specific health insurance policies.
Agents do rely on earning a commission for signing people up for insurance. They can still earn a commission when signing someone up through the marketplace, but clients don’t pay that fee — the insurance companies do.
Dawn Hartis, an agent with Stanberry Insurance in Waynesville and Sylva, said an agent could better explain how subsidies work and the differences in copays, deductibles, HMO plans and PPO plans.
“Navigators are there to walk you through the process of signing up, but they are not there to recommend a specific health plan,” she said. “We’ve found there is a lot of confusion regarding subsidies and how to determine whether you’re eligible for a subsidy.”
Without someone knowledgeable enough to make sure clients get the correct subsidy, Hartis said people could end up owing a lot of money back to the government when taxes are due. People who have signed up on the marketplace should receive a form to fill out and submit when they file their taxes.
Rogers has been in the business for 44 years and said the process isn’t as simple as some people think.
“You can’t just sit down and do it on the phone with navigators who have a couple of months of training,” he said. “I think they are helpful, but I don’t know that they have the proper training to select a company and a plan.”
Demand of services
Despite the push toward seeing a navigator, insurance agents are still signing plenty of people up for health insurance. During the first year of open enrollment, Blue Cross Blue Shield was the only marketplace provider in North Carolina.
Hartis said Stanberry was busy with new clients thanks to referrals, advertising and health insurance seminars.
The 2015 open enrollment deadline is Feb. 15 to have coverage begin March 1, but Hartis recommends getting signed up as soon as possible.
“Don’t wait till Feb. 15,” she said. “We had people coming in Dec. 14 for last deadline (Dec. 15) and the volume just can’t be handled, so the earlier the better.”
Carroll Smith with Smith Insurance Services in Sylva said he hadn’t received the calls he thought he would during the current open enrollment period despite placing advertising in local newspapers.
Current clients have called to update their policies for 2015, but Smith said he had very few new policies through the marketplace. With the Feb. 15 deadline looming, Smith said he hopes to sign more people up for health care. The penalty for not having insurance in 2014 was $90, and that penalty increases to $325 in 2015.
“I didn’t have the number of calls I thought I would and I don’t understand that,” he said. “The penalties are going to get steeper every year.”
Rogers said having navigators taking over the role of the agent has hurt his industry over the last couple of years. However, the navigators, who are funded through a federal grant program, will be gone after this year’s enrollment period.
“So what will people do when they have a billing question or a claim problem?” he said. “Buying a policy is one thing but the service goes along with it — that’s the total package.”
On the other hand, Rogers said his business has done well with sign-ups through word of mouth advertising and developing relationships over 40 years. He added that he has helped many people who signed up using a navigator and then felt like they got the wrong plan.
Words of wisdom
North Carolina now has three insurance carrier options — BCBS, CoventryOne and United Healthcare — but agents warn that not all carriers can offer the same services in this region.
Rogers said residents might be eligible for cheaper plans through the other companies, but they should also take into consideration that many of the health care providers in Western North Carolina are in the BCBS network. It’s important to know which physicians are in the network.
Rogers said there are many aspects of ACA that can be better explained by insurance agents. He said it’s more than just signing up for insurance now — the plan chosen and the subsidy given will affect everyone’s tax returns.
“The biggest challenge with this issue is now the IRS is in charge of your health insurance because it’s based on subsidies, which is based on payrolls and income,” he said. “When they file their taxes, people are going to be surprised with the penalties.”
Rogers said many people might have underreported their income or might have received a subsidy when they actually weren’t supposed to qualify for one. Those people will end up owing the government money come tax time.
Hartis said people are eligible for a subsidy only if they meet the financial hardship requirements and are not eligible through an employer’s group policy. She also said people who didn’t sign up by the Dec. 15 deadline for their policy to go into effect Jan. 1 will receive a pro-rated penalty.
Keeping up with the new rules and regulations under ACA means additional training for insurance agents, but it’s something they’ve become accustomed to in a changing industry.
Hartis, who has been an agent for 20 years, said she goes through 12 hours of training a year for ACA on top of Centers for Medicare & Medicaid Services (CMS) and Blue Cross Blue Shield training each year.
“You just got to roll with the punches,” she said.