Consumer Assistance Remains Key to Medicaid, ACA Enrollment Process

Around one-fifth of Americans continue to rely on consumer assistance to navigate their healthcare coverage options, but not all of them can access the help that they need, a Kaiser Family Foundation (KFF) study revealed.

The study, conducted in the spring of 2020, surveyed more than 2,000 nonelderly consumers who were in qualified health plans, Medicaid, or uninsured to ask about their utilization of consumer assistance.

Of those surveyed and who had looked for coverage or were seeking coverage, 18 percent said they sought help outside of friends and family in their decision-making process. Four in 10 of these said that they may not have found coverage without this support.

The majority of those who were shopping for, applying for, or renewing a health plan or Medicaid, 81 percent said that they did not receive outside help.

However, these individuals may have still benefited from assistance in the past. Around one in five of those who renewed their healthcare coverage without help stated that they received help their first year enrolling.

Over nine in 10 of the respondents who received outside consumer assistance (94 percent) rated that assistance as somewhat or very helpful. Many returned to the same source of consumer assistance that had helped them previously.

Consumers have several options when looking for assistance, such as federally funded and state-funded Navigator programs, brokers commissioned by insurers, and non-profits.

To locate assistance, many consumers went to state or federal marketplace websites or relied upon verbal recommendations. Forty percent turned to a Navigator or certified enrollment assistance program. Another 36 percent sought out a broker’s help.

Consumers may seek help for a variety of reasons and at any stage in the enrollment process, the KFF study discovered.

More than six of 10 respondents (62 percent) said they sought help in deciding on a health plan because they could not understand their coverage options. Another common reason was that the application process itself was too complex to finish without support.

Other consumers encountered practical barriers, such as internet access, website issues, or language barriers.

“Resources to provide consumer assistance through the marketplace are limited and have been cut severely in recent years,” the study stated. “Yet, the need for consumer assistance still appears to be large.”

In 2018, CMS chose to cut funding for Navigator programs.

Those who still needed assistance would turn towards agents and brokers that do not take their payment from state or federal government budgets, the agency reasoned. A call center run by contractors received a 90 percent satisfaction rate and cost far less than the Navigator program, CMS Administrator Seema Verma said.

But the KFF study argued that the current support was insufficient to meet consumer needs.

Twelve percent of the respondents said they sought but could not obtain consumer assistance. Scaled nationally, this would equate to almost 5 million individuals who could not secure support to navigate the healthcare coverage decision-making process, even though they actively pursued help.

And even among those who did receive support, sometimes the assistants pushed plans that experts have argued are insufficient—specifically when the assistants were brokers or private payer representatives.

One-fourth of respondents who secured a plan using consumer assistance from brokers or a private payer representative reported these representatives offered plans that did not comply with the Affordable Care Act.

These plans, such as short-term limited duration plans, can leave consumers exposed to higher healthcare spending.

Individuals who did receive consumer support did not differ much demographically from those who did not get consumer support. The largest distinction was that Hispanics were more likely to receive assistance than White respondents. Nearly a quarter of Hispanics who sought help received assistance (23 percent).

Overall, these statistics confirm that there is a surplus of individuals who are interested in receiving consumer assistance and who are not securing help, KFF argued.

“Millions are at risk of losing their job-based coverage,” the study pointed out. “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,” it concluded.