Brokers, Assisters Share Affordable Care Act Marketplace Consumer Trends

Assister programs and brokers found that consumers lacked awareness about Marketplace subsidies and rules and experienced delays in receiving their final eligibility determination, according to a national, online survey from KFF.

Brokers and assister programs share certain goals but differ in that broker programs tend to be less likely to enroll consumers in Medicaid or Children’s Health Insurance Plans (CHIP), do outreach, or serve uninsured, Hispanic, or immigrant populations. Federally qualified healthcare centers and Navigators  are considered assister programs.

Over half of assisters and brokers reported that consumers struggled to understand basic health insurance terminology. Household income and household composition were challenging for consumers to assess. More specifically, nearly two-thirds of assisters and two-thirds of brokers found that consumers lacked awareness of Affordable Care Act benefits and rules.

Assisters and brokers tended to spend about one to two hours with first-time enrollees applying for Affordable Care Act marketplace coverage and one hour with returning consumers looking to renew or switch coverage.

The assisters found that the reasons that consumers sought out enrollment support had not changed significantly in the last six years.

In 2022 as in 2016, the primary reason that consumers sought enrollment support was because they did not have the confidence to apply on their own, followed by needing help understanding their plan options and a low level of understanding about the Affordable Care Act. One of the biggest shifts was a spike in the share of programs reporting that most or all their clients required language assistance.

Seven out of ten assister programs found that most or nearly all of their clients did not know that the American Rescue Plan Act had boosted subsidies. Four out of ten respondents said that nearly all their consumers learned about the enhanced subsidies from the assister program and a little less than a third said that most of their consumers learned about it from the assister program.

Around six out of ten assisters said that the demand for assistance exceeded their ability to help. During the pandemic, assisters branched out into using remote assistance. However, 26 percent found that the quality of assistance was not as good as in-person support, while 68 percent said that the quality was about the same.

“Most assisters believe the number of plan choices is about right, but comparing Marketplace plan options posed challenges for some,” the survey found. “In many states this year consumers faced a choice of more than 100 QHP options.”

A little more than a third of assister programs indicated that the distinctions between health plan benefits and costs were not significant enough for consumers.

Among brokers, nearly two-thirds of respondents assisted as many as 100 consumers during the Affordable Care Act marketplace open enrollment period for 2022 and around 20 percent of brokers helped over 200 consumers. Additionally, nearly four out of ten brokers helped ten or fewer consumers with a special enrollment period and eight out of ten brokers helped consumers during the extended COVID enrollment period.

Brokers often did not rely on the Affordable Care Act marketplace website. Most brokers in states on the federally-facilitated marketplace did not start clients’ applications on the federal website, HealthCare.gov. This share was lower in states where direct enrollment platforms were allowed but not enhanced direct enrollment platforms.

Brokers tended to use private sites because filling out a qualified health plan on a private site can take less time. Six out of ten brokers also mentioned that private sites frequently have dashboards and tools to help them track their clients’ application progress. Private sites also allow brokers to track client notices and offer client communication tools, some respondents noted.

Experts are concerned about the impending end to the public health emergency and how it will impact consumers on the Affordable Care Act marketplace and on Medicaid.

Most assisters expected to engage in outreach to ensure that enrollees know about the end of the public health emergency. Nearly two-thirds of assister respondents agreed that the state should extend an Affordable Care Act marketplace special enrollment period for enrollees who lose Medicaid coverage.

“Both Assister Programs and brokers indicated they will try to re-contact Medicaid clients to update contact information, and most were confident they could reach their clients,” the researchers noted.