Insurance agents vie against 'navigators' for share of NC subsidized insurance market

jmurawski@newsobserver.comSeptember 20, 2013 

Insurance agents are vying for a share of the massive insurance market created by the Affordable Care Act, a law that will make it illegal for most Americans to be uninsured.

Agents are boning up on the subtleties of the health care law and burnishing their professional credentials to attract potential customers who have never shopped for insurance.

In one of the more extensive strategies, Endeavor Insurance Services, a South Carolina company, is launching a national website called HealthAviator to sign up insurance customers and collect a commission from every online sale in 48 states. Endeavor is also deploying a mobile office-on-wheels that will set up operations at the N.C. State Fair next month, among other places in the state.

With more than a million people in North Carolina expected to shop for subsidized insurance as of Oct. 1, the Patient Protection and Affordable Care Act opens a lucrative, untapped market to insurance agents. At the same time, the health law will give the public choices on how they buy insurance, whether through self-guided online tutorials, through licensed insurance agents, or through “navigators” and volunteers who will be trained to do outreach and enrollment for subsidized coverage.

Some agents and their professional associations are going on the offensive and saying they are best-equipped to coach the public on complicated insurance questions. The HealthAviator site is being promoted as a superior alternative to the official U.S. site, healthcare.gov, as well as would-be competitors.

“If you call or work with anyone about a policy to purchase through HealthAviator, you will be working with a licensed insurance broker, not some Joe who was serving coffee at Starbucks last week,” said Aaron Perlut, spokesman for the HealthAviator project.

Meanwhile, health care advocates warn that agents work for commissions and may steer customers to policies that generate the most generous commissions. Some agents sign exclusive contracts to send customers to one insurance company without disclosing other insurance options that might be available under the Affordable Care Act.

“What’s deeply concerning is some of these organizations putting down navigators or other resources,” said Adam Linker, a health policy analyst at the N.C. Justice Center. “The navigators are obliged to share information about all the plans. A lot of the hard-to-reach, low-income population is exactly the people that Legal Aid has known and understood since its inception.”

‘Insurance is complicated’

Much of the enrollment under the Affordable Care Act in North Carolina will be handled by counselors and navigators working for groups such as the Legal Aid Society and the Benefit Bank. These advisers, who will receive either a minimum of 5 hours or 20 hours of training, will be culled from the staff and volunteer ranks of community health centers and other social service groups.

All approaches will be needed to sign up the crush of people expected to shop for insurance under the Affordable Care Act, said Robert Luisana, managing partner of the Pilot Benefits, an employee benefits company in Greensboro. The law includes penalties for failing to sign up, $95 or 1 percent of income, whichever is greater, and increasing in subsequent years. There are various exemptions from the penalty for people with economic hardships and other circumstances.

The law also includes subsidies for people below certain income levels to offset the cost of buying insurance. In other major changes, the Affordable Care Act prohibits insurers from rejecting customers with pre-existing conditions and from other practices that had been standard for decades.

“There should be an agent involved in every situation,” said John Adair, CEO of Endeavor in Greer, S.C. “I’ve met some of the navigators, and they’re certainly nice people and educated. But insurance is complicated.”

Exclusive contracts

Some independent agents work under exclusive contracts for Blue Cross and Blue Shield or Coventry Health Care of the Carolinas, the only two companies that will offer subsidized policies in North Carolina. Other agents will accept commissions from both companies.

One major difference between insurance agents and navigators and counselors is that agents can recommend a policy they think is best for a customer, while the federally funded advisers aren’t permitted to offer their expert opinion.

Luisana said working through an agent may be especially advisable for customers who have complex health conditions, take multiple medications and use certain specialists. He said that Blue Cross and Coventry will offer cheap insurance plans that may exclude certain doctors and hospitals from their networks, and such omissions may slip past an inexperienced insurance assistant who is focused on price tags only.

David Smith, vice president of Ebenconcepts, an employee benefits company in Fayetteville, said his company is building a website to sell subsidized policies online in six states. Smith, a past president of the N.C. Association of Health Underwriters, said shopping for insurance is not a game for amateurs.

“It’s not going to be a simple transaction,” Smith said. “It’s not like buying an airline ticket. It’s probably more like buying a house. You have to consider where it’s located, how old it is, do you want a porch or a garage, and so on.”

Murawski: 919-829-8932

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