CMS's Center for Consumer Information and Insurance Oversight (CCIIO) has outlined the roles for traditional insurance brokers and web-based brokers assisting customers in public exchanges.
In addition to assisting individuals and families, CCIIO said it "anticipates that agents and brokers will play a critical role in helping qualified employers and employees enroll" through the small business or SHOP program.
At the same time, the Affordable Care Act's delegation of broker regulation to states -- and to a lesser extent navigators -- means that the consumer experience may vary somewhat across the country, even in the federal exchanges.
[See also: Private HIXs look for a role in public exchanges]
For instance in Ohio, one of 26 states that will have a federal exchange, the group Ohio Consumers for Health Coverage is criticizing a new law that requires navigators to undergo certification, background checks and continuing education -- many of the same requirements placed on brokers, and potentially limiting navigator positions to existing brokers and agents.
CCIIO, though, sees a place for navigators, in-person assistors, brokers, agents and web-based brokers (sites like eHealthInsurance.com that could work with the public exchange in their state) -- with one important distinction being that agents and brokers, unlike navigators, can recommend specific health plans.
In its guidance, CCIIO said agents and brokers will be able to help consumers through "an issuer-based pathway," working with consumers using an insurer's website, or "a Marketplace pathway," assisting consumers in searching through and purchasing from the exchange website.
In the issuer-based pathway, agents and brokers have to inform consumers if they'll only provide information on qualified health plans they have business affiliations with and also note that consumers can access the exchange website to view other options. State exchanges, as directed by state law, can also require brokers to present consumers with all qualified health plans and to disclose their compensation with insurers.
Brokers will also have to work with every individual or family approaching them for help, including people eligible for Medicaid and CHIP.
Agents and brokers working with a federal or partnership exchange will have to register and complete an online training course, and will receive a unique identifying number, along with a national producer number that can be used for receiving compensation from an insurer.
CCIIO also offered some elaboration on web-based brokers, a concept first outlined in interim final rules published in March 2012.
"We expect web-brokers to provide another option for consumers seeking to enroll in QHPs through the Marketplaces for individual products, alongside traditional agents and brokers," CCIIO officials wrote, adding that "CMS recognizes that many consumers currently purchase insurance online from web-brokers."
State exchanges can allow web-brokers to offer consumer information for comparing and selecting QHPs, and federal exchanges intend to as well, to the extent permitted by state law.
"CMS is developing the capability to support integration between the web-broker's website and the Federally-facilitated Marketplace's website using secure redirect and application programming interface mechanisms," CCIIO officials wrote.
That'll allow consumers to start their shopping on the web-brokers' sites, connect to the federal exchange for eligibility applications and then return to the web-brokers' sites for comparing and selecting health plans. After consumers select a qualified health plan and their advance premium support amounts have been determined, the web-broker will transmit the selection, premium and broker identifier back to the federal exchange.
CCIIO noted that web-brokers have to display all qualified health plans, regardless of business relationships, although the agency said that web-brokers can offer additional tools or decision support to help consumers "navigate or refine the display of QHPs."