Kaiser Family Foundation Survey on Assister Programs Reflects Signs of Progress – and Opportunities for Improvement

By Emma Chapman

On June 8, Kaiser Family Foundation (KFF) issued its third Survey of Health Insurance Marketplace Assister Programs and Brokers. This annual report adds to the growing body of evidence – including CHIR’s own recent report about the Assister Help Resource Center – on how Assister Programs are helping consumers navigate the often complex and time-intensive process of enrolling in marketplace plans. The 2016 findings in KFF’s report demonstrate that assister programs continue to be integral resources for millions of consumers across the country, but opportunities remain to assist more consumers and streamline the enrollment process. See below for some key findings from the survey.

Fewer consumers were assisted through Assister Programs this year. During Open Enrollment, assisters helped 5.3 million – compared to 5.9 million in 2015. This decrease may have been because some consumers no longer needed assistance, particularly because of the auto-renewal option, but the survey also noted that other factors like a lack of public awareness and affordability concerns may have contributed to it. In addition, 21% of programs reported turning away consumers during the last two weeks of enrollment, when there was a surge in demand.

 A growing number of consumers sought help with renewing coverage. In 2015, 53% of programs reported that most or nearly all consumers were seeking new coverage; by 2016, only 29% reported that most consumers were seeking new coverage, while 39% of programs reported that most to nearly all consumers sought help to renew coverage.

There were significantly fewer uninsured than in prior years. While a growing proportion of consumers sought to renew coverage, 55% of programs reported that most or nearly all of their consumers were uninsured when they sought assistance. This could mean that consumers lost coverage during the year and returned to re-enroll during Open Enrollment. Still, however, the proportion of uninsured represents a 28 percentage point decrease from 2015, when 83% of programs reported that most or nearly all were uninsured.

Assister Programs and their staff are staying put, for the most part. Assister programs have developed strong relationships with the communities they serve, particularly those that have been able to offer services over all three open enrollment periods. Eighty-seven percent of programs have operated since the first Open Enrollment in 2014, while 94% are returning from 2015. Similarly, nearly 70% of programs reported that all or most of their staff had worked during all open enrollments.

 Helping to enroll consumers takes time. It took 90 minutes on average to assist consumers who were applying to the Marketplace for the first time – a metric that has remained unchanged since 2014. Similarly, just as in 2015, it took an average of 60 minutes to assist a consumer who was renewing coverage.

Additional coordination may lead to increased effectiveness. While a majority (66%) of programs reported that coordination with other programs improves effectiveness, 59% reported that they rarely – if ever – actually do so. Programs with smaller caseloads were less likely to have coordinated with others: 1/3 said they never coordinated with other programs, compared to 10% of programs with large caseloads.

Technical problems have decreased, but identity verification problems remain. Fewer Assister Programs reported that consumers faced difficulty utilizing the online marketplaces. However, between 3-10% of consumers still had trouble with the identity-proofing process, which required a follow up visit. A fourth of all programs indicated that more training on resolving such problems would be helpful.

Insurance literacy is improving, but additional assistance is needed. Sixty-two percent of programs said that most or all of their consumers needed help understanding common insurance terms – down from 74% in 2015. However, 30% of programs sought additional training in health insurance literacy.

Assister Programs are going beyond. Assister Programs provided post-enrollment assistance to at least 745,000 customers between the 2015 and 2016 open enrollment periods although not required to do so. Common areas of assistance included: payment and invoicing problems, claim denials, out-of-network benefits, and using health insurance. In addition, Assister Programs helped at least 830,000 consumers enroll through special enrollment periods – a 30% increase from 2014.

Assister Programs continue to provide much-needed services to consumers who face difficulties understanding how to enroll in and understand insurance plans. The survey’s findings further indicate that these programs will continue to be needed in the future given the knowledge gaps that still exist among consumers and high proportion of individuals who seek help with renewal.

Editor’s Note: Emma Chapman is a student at Georgetown University Law School.

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