Agents and Brokers in the Marketplace July 2019 · The information provided in this presentation is intended only as a general informal summary of technical legal standards. It is

Agents and Brokers in the Marketplace

July 2019

The information provided in this presentation is intended only as a general informal summary of technical legal standards. It is not intended to take the place of the statutes, regulations, and formal policy guidance that it is based upon. This presentation summarizes current policy and operations as of the date it was presented. Links to certain source documents have been provided for your reference. We encourage audience members to refer to the applicable statutes, regulations, and other interpretive materials for complete and current information about the requirements that apply to them.This document generally is not intended for use in the State-based Marketplaces that do not use HealthCare.gov for eligibility and enrollment. Please review the guidance on our Agents and Brokers Resources webpage (http://go.cms.gov/CCIIOAB) and Marketplace.CMS.gov to learn more. Unless indicated otherwise, the general references to “Marketplace” in the presentation only includes Federally-facilitated Marketplaces (FFMs) and State-based Marketplaces on the Federal Platform.This communication was printed, published, or produced and disseminated at U.S. taxpayer expense.

Disclaimer

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Agenda

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• The individual market: What does it look like?• Exchange market: At-a-glance• Agents & brokers: Your important role• Helping You: How CMS continues to improve the experience

for agents and brokers

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Individual Market is Relatively Small but Important

178,500,000

57,100,000

70,900,000

16,000,000

EMPLOYER-BASED (GROUP) MARKET

MEDICARE (OVER 65) MEDICAID (POOR AND DISABLED)

INDIVIDUAL (NON-GROUP) MARKET

Covered Lives, 2016

Agenda

• The individual market: What does it look like?• Exchange market: At-a-glance• Agents & brokers: Your important role• Helping You: How CMS continues to improve the experience

for agents and brokers

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Nationwide Plan Selections during 2015 – 2019 Open Enrollment Period

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Total HealthCare.gov Plan Selections 2018 and 2019 Open Enrollment Periods

8,743,6428,411,614

0

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

7,000,000

8,000,000

9,000,000

10,000,000

Plan Selections

2018 20197

Seamless Enrollment Experience

Primary goal of providing a seamless enrollment experience for HealthCare.gov consumers

• Consumer satisfaction rate at the Call Center remained at an all-time high – averaging 90 percent

• Waiting rooms did not need to be deployed online during the final days of Open Enrollment.

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Agents and brokers accounted for 43.6% of enrollments during the PY19 Open Enrollment period, up from 40.0% in

PY17 and 41.8% in PY18.

40.0%

41.8%

43.6%

38%

39%

40%

41%

42%

43%

44%

Agent or Broker

Enrollments by Assister Type

PY17 PY18 PY19

Perce

ntage

of E

nroll

ments

Note: Enrollment data is current as of the end of each Open Enrollment period in states using the Federal platform.

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Who are our consumers? Enrollment Type

Automatic Re-Enrollment - 24% New Consumers - 27%

Active Re-Enrollment - 47%

*2019 Open Enrollment Report10

Who are our consumers? Income

100-250 FPL71%

19%251-400 FPL

10%Other HHI

*2019 Open Enrollment Report11

Who are our consumers? Gender

55%45%

Female Male

*2019 Open Enrollment Report12

Who are our consumers? Location

18%

82%

Location

Rural Urban

*2019 Open Enrollment Report

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Who are our consumers? Metal Level

1%

30%

61%

7%

Metal Level

Catastrophic

Bronze

Silver

Gold

Platinum

*2019 Open Enrollment Report14

PY 18 National Exchange Issuer Participation by Geography

-All State Exchange data is self-reported from Exchanges to CMS (CA, CO, CT, DC, ID, MA, MD, MN, NY, RI, VT, WA)-Federally-facilitated Exchange data reflected on this map is point in time as of 10/20/2017

# of PY 18 Exchange Carriers0 Carriers (0 Counties)1 Carrier (1,565 Counties)2 Carriers (894 Counties)3 Carriers (333 Counties)>3 Carriers (350 Counties)

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PY 19 National Exchange Issuer Participation by Geography

# of PY 19 Exchange Carriers0 Carriers (0 Counties)1 Carrier (1,110 Counties)2 Carriers (1,191 Counties)3 Carriers (451 Counties)>3 Carriers (389 Counties)

- All State-based Exchange data is self-reported from the Exchanges to CMS (CA, CO, CT, DC, ID, MA, MD, MN, NY, RI, VT, WA)- Federally-facilitated Exchange data reflected on this map is point in time as of 09/28/2018

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Outlook: Premiums Change in Average Second Lowest-Cost Silver Plan Premium for HealthCare.gov States

2015-2019

3%

8%

24%

37%

-2%-5%

0%

5%

10%

15%

20%

25%

30%

35%

40%

2015 2016 2017 2018 2019

Source: 2019 Health Plan Choice and Premiums in HealthCare.gov States https://aspe.hhs.gov/system/files/pdf/260041/2019LandscapeBrief.pdf

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Impact of State Innovation

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Agenda

• The individual market: What does it look like?• Exchange market: At-a-glance• Agents & brokers: Your important role• Helping You: How CMS continues to improve the experience

for agents and brokers

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Important Role of Agents and Brokers

• Who you are: • More than 50,000 agents & brokers registered with

HealthCare.gov• Where you are:

• Agents and brokers in every state• What you do:

• Enroll millions of people in health insurance!

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Agent- or Broker-Assisted Enrollments by StatePlan Year 2019

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Agent and Broker Registration Activity

42,661 40,128

6,752 7,941

-

10,000

20,000

30,000

40,000

50,000

60,000

PY18 PY19

Regi

stra

tions

New vs. Returning Agents and Brokers

Returning New

• The total number of registered agents and brokers fell by approximately 2.7% from PY18 (49,413) to PY19 (48,069).

• The number of newly registered agents and brokers increased 17.6% from PY18 (6,752) to PY19 (7,941).

• The number of returning agents and brokers decreased 12% from PY18 (42,661) to PY19 (40,128).

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Circle of Champions

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Over half of active agents and brokers in plan year 2019 qualified.

Circle of ChampionsPlan Year 2019

17,322

6,414 885

2,673,854

2,152,693

994,605

- 2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 18,000 20,000

-

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

Standard Elite Elite Plus

Num

ber o

f Qua

lifie

rs

Num

ber o

f Enr

ollm

ents

Circle of Champions Level

Qualifiers Enrollments

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Help On Demand

• Help On Demand experienced a 31% increase in agent and broker participation for PY19, from 5,332 to 6,973 active agents and brokers.

• These agents and brokers responded to 74,008 referrals for PY19 Open Enrollment, up 28% from 57,676 referrals for PY18.

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Agenda

• The individual market: What does it look like?• Exchange market: At-a-glance• Agents & brokers: Your important role• Helping You: How CMS continues to improve the

experience for agents and brokers

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Improvements to Agent and Broker Program

• Enhanced Direct Enrollment• Help On Demand • Technical Assistance• Training and Registration• Circle of Champions• Find Local Help• Future Improvements for 2019 and Beyond

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