On the Exchange or Off the Exchange, That is the Question

By Bonnie Bochniak
Vice President, Government Relations
MBPA/MFBA

March 2013 – With the October 1, 2013 date of open enrollment approaching for individuals wanting to participate on the federal healthcare exchange, many people are feverishly scanning the draft enrollment process to get a feel for what lies ahead.

At first blush, the process for a family of three is a 15-page application. The outline of the online version has 21 steps, with some having additional questions. After submitting your application, the plan then is sent through three major federal agencies, including the IRS, who examines your paperwork, double checking your identity, income and citizenship. The analysis of your application is supposed to happen in real time, if you apply online.

The initial application process is step one, as this lets you and the federal government know if you qualify for any financial assistance.  Since the PPACA is means-tested, lower income individuals will qualify for the most financial support when paying premiums. If you or your spouse had a change in financial status that the federal government isn’t aware of, that might qualify you or disqualify you for financial assistance, additional paperwork would have to be submitted and additional questions answered.

After the financial portion is complete, then the individual, family or business, moves onto choosing which health plan suits them best. Choosing a health plan will require additional steps, and a general knowledge of insurance terminology. The federal government states that this process should take individuals on average 30-45 minutes to complete, with the ability to walk away from their computer to gather needed materials, and save their place on the program.

The unanswered question still remains, will individuals be able to navigate on the web portal themselves, or out of frustration will they opt out and go back to the private market. The general feedback is that this application and choosing one’s own healthcare will be more complex and take more time to fill out than the estimated 30-45 minute timeframe. This then beckons to question the necessity for the insurance agent’s role both on and off the exchange to help navigate individuals towards the right plans for them, their families and/or their business.

From what we have seen thus far, the role of the insurance agent will be needed now more than ever before, to help guide an individual, a family or a business both on and off the exchange. As we move closer to the January 1, 2014 deadline, more details will become available, and we will share those with you.  As always, please contact our government relations team at bbochniak@michbusiness.org or by phone at 586-393-8800.