14% of official HCgov enrollees via 3rd-party web broker?

Disclosure: HealthSherpa has a banner ad on this site...for the following reasons:

  • Their website only sells ACA-compliant plans.
  • They display all of them equally (as opposed to hiding or favoring one over another).
  • They only sell them on-exchange (if you're eligible for ACA subsidies you get them through HS's site as well)
  • They make it easy to enroll fro Medicaid/CHIP if the enrollee isn't eligible for a subsidized ACA policy.

It's really, really important to me to make the above very clear, for the following reasons as laid out by Tara Straw of the Center on Budget & Policy Priorities:

  • Many DE entities offer plans that don’t comply with ACA standards, and they may benefit financially if they enroll more people in them. Some insurers and brokers operating through DE offer short-term health plans and other types of plans that don’t meet ACA consumer protections and benefit standards but pay high commissions to agents and brokers. Federal rules bar DE entities from displaying these plans alongside marketplace plans, but some DE sites use screening tools to shift consumers away from marketplace options. This raises a serious threat to both consumers and the ACA marketplace if insurers and brokers use their status as approved DE entities to enroll consumers in non-compliant plans. Also, the sites’ screening tools collect personal and health information that can be used for future marketing of non-compliant plans.

For example, one web broker’s listing of “Health Insurance” options often shows only non-ACA plans; the site lists ACA-compliant plans under “Obamacare Coverage.”

  • People who are eligible for Medicaid or other programs may face additional barriers to enrolling when they rely on a DE website. The marketplace has a “no wrong door” policy, meaning that consumers who go to the marketplace website can fill out one application and be routed to Medicaid, CHIP, or marketplace subsidies based on the information they provide. But some DE websites divert consumers from the marketplace application process before they even reach it, by not informing them that they might be eligible for no-cost coverage or by steering them toward non-ACA products.

One health insurance issuer encourages consumers with Medicaid-eligible children to “buy a plan direct” from them, which bypasses the marketplace’s single streamlined application that would indicate their child’s Medicaid eligibility.

  • DE websites prevent consumers from fully comparing private health plans based on price and quality, which impedes competition among insurers. Unlike marketplace websites, which allow people to compare all qualified health plans on an apples-to-apples basis, DE entity websites may not present all available marketplace plans or comparable plan information. Moreover, DE entities may have financial incentives to steer consumers to certain insurers. Consumers thus may not end up with the plan that would best meet their needs. Moreover, insurers with significant market share can use DE and EDE to maintain their dominance, making it harder for small insurers or new entrants to compete.

One web broker lists what appears to be a complete list of plans (“17 of 17”) available in a rating area but in reality covers only about one-third of the available plans.

With all that out of the way, this is a pretty eyebrow-raising tweet from HS's CEO:

The first week of #OpenEnrollment is now over, and I’m thrilled to share that @healthsherpas has already helped over 120,000 people enroll at a median net premium of $39/month. There is very affordable coverage available this year-don’t wait until the last second to #GetCovered!

— George Kalogeropoulos (@GeorgeK_HS) November 8, 2019

That's 120,000 on-exchange QHP selections via an authorized 3rd-party web broker (for HC.gov states only). What makes this especially noteworthy is that it's within the first seven days only.

For comparison, to the best of my reckoning, last year total HealthCare.Gov enrollments hit around 823,000 QHPs during the first seven days of Open Enrollment when you account for Nevada splitting off onto their own full ACA exchange. 

Note that both numbers only include the 38 states on the federal exchange; the numbers and patterns for the 13 state-based exchanges could be different.

In any event, this means that assuming similar enrollment patterns this year (which may not be the case), HealthSherpa has enrolled over 14% of all HC.gov enrollees to date. Huh.