In a perfect world, the exchanges provide consumers with comprehensible questions to help determine which plan best accommodates their needs. But as time has proven, the PPACA and the exchanges are far from perfect. And one tweak to the new legislation has some insurance brokers and financial planners on edge.
The PPACA requires state exchanges to establish a “navigator” program, whereby navigators must guide and advise consumers on their coverage choices. Unlike insurance agents, brokers—and that 16-year-old kid who’s been using your trashcans to nail his parallel-parking exam—these navigators need not be licensed.
“Navigators can help people supposedly sign up for plans, which can be scary,” says Lindsay Adams, an agent with Insphere Insurance Solutions. “One: they don’t understand the market. And two: they have access to social security numbers, birth certificates, and other personal information. Licensed agents need a spotless background, whereas ‘navigators’—who knows.”
After relocating to Colorado this past summer, Donna Gray and her husband were looking to sign up for a Medicare Advantage plan with Anthem BlueCross BlueShield. Medicare is the federal health insurance program for people over 65, young people with disabilities, and those with permanent kidney failure. Advantage plans are Medicare health plans offered by private companies that have contracts with Medicare. Advantage plans cover hospital, medical, and usually offer some prescription drug insurance.
For Gray, a senior who does not have high prescription drug costs, the Medicare Advantage program was attractive because it included vision and dental benefits, which her regular BlueCross BlueShield plan did not. She quickly discovered, however, that she too needed someone to help her “navigate” the system.
“It shouldn’t be this hard,” Gray says, inundated by the two folders she clasps, stuffed to the brim with important documents, rules and contacts. “There’s just so much information to go through. I was on the Internet, getting all kinds of information, and it just swamps you.”
Luckily, Gray decided to go with a licensed broker to help her figure things out.
Under ObamaCare, the federal government estimates that it will cut a total of $716 billion from Medicare, which will then be reinvested into the PPACA, including Medicare programs. With this, they can offer new benefits for seniors and close the Medicare Prescription Drug Coverage gap, aka donut hole. As of 2010, Medicare recipients had to pay monthly premiums for the coverage, as well as 100 percent of drug costs, until they had paid a total of $310 out of pocket.