The Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS) issued a notice recognizing that agents and brokers will play an important role in communicating coverage offered under the federally-mandated health insurance Exchanges. Specifically, agents and brokers, including web brokers, will be called on to educate consumers about Exchanges and insurance affordability programs, to help consumers receive eligibility determinations, compare plans and enroll in coverage. CMS anticipates that brokers and agents will be integral to helping qualified employers and employees enroll in coverage offered through the Small Business Health Options Programs (SHOP).
The CMS guidance acknowledges that the government will work with agents and brokers, and also provides an overview of their expected role. CMS anticipates that agents and brokers will assist consumers in completing the Exchange eligibility application and will provide advice for comparing and selecting qualified health plans offered through the Exchange. Agent and broker assistance will take one of two approaches: (a) an issuer-based pathway, through which an agent or broker users an issuer’s website to help the consumer, or (b) a Marketplace pathway through which an agent or broker uses the Exchange’s website to help the consumer. Either approach will provide the agent/broker the opportunity to provide identifying information to the issuer for the issuer’s payment to the agent/broker for each enrollment transaction. Either approach will also allow the agent/broker the right to assist both employers and employees with initial enrollment and mid-year coverage changes.
Agent/brokers will have to register with CMS to be recognized by the Exchange. An online enrollment process is expected to be operational this summer.