Assistance services for health insurance marketplace enrollees lacking
Just 18% of those who were looking to enroll or renew coverage were able to find a consumer assistance program to help them through the process.
This year, an unprecedented number of people who have lost their employer-sponsored health coverage will be turning to the individual market for a new plan. Unfortunately, many may be on their own when shopping for coverage.
A recent study from the Kaiser Family Foundation found that just 18% of those who were looking to enroll or renew coverage in a Medicaid or individual plan were able to find a consumer assistance program to help them through the process, while one in eight people wanted help but were unable to find any.
Health insurance is confusing for many Americans, and recent changes to the Affordable Care Act have only added to the mess. According to the report, many consumers are unsure if the ACA is still in effect and do not know if they’re eligible for Medicaid or what the enrollment dates are. Of those seeking assistance in enrollment, 62% said they did not understand the available coverage options, and 52% feared the enrollment process would be too complicated.
Overall, the shortage of assistance services is preventing many consumers from understanding their coverage options. Though worsened by the pandemic, the lack of assistance has been an issue in recent years, with funding for Navigator services dropping 84% since 2017. The most commonly cited reason for being unable to access assistance was that they couldn’t find help close enough to home (32%), followed by being unable to get an appointment (30%).
The Trump administration has been pushing alternatives to Navigator programs, such as the use of brokers or online sites such as enhanced direct enrollment (EDE) sites. However, such alternatives may be steering consumers away from full health insurance coverage. According to the study, 22% of consumers who used an EDE site said they were offered alternatives such as short-term health coverage, and 25% were offered non-compliant policies such as hospital indemnity or cancer coverage as a supplement to their coverage. And while Navigator specialists are prohibited from recommending non-ACA compliant plans and encouraged to only offer objective guidance, 81% of those who used an EDE site or other non-Navigator representative received a specific policy recommendation.
“During this pandemic, millions are at risk of losing their job-based coverage,” the report concludes. “While most will be eligible for replacement coverage through the marketplace or Medicaid, transitioning to these programs will not be intuitive or easy for many people. Greater availability of consumer assistance would help people losing employer-based insurance navigate their coverage options, but those options still could prove to be unaffordable for some.”
Read more: