About 42percent of enrollments for 2018 ACA plans were arranged throughsales agents or brokers, with many of them relying on suchalternative websites to enroll their clients, noted the report.(Photo: Shutterstock)

Some websites consumers use to buy their own health insurancedon't provide full information on plan choices or Medicaid eligibility, and appear to encourageselection of less comprehensive coverage that provides highercommissions to brokers, according to a report released Friday by the left-leaning Center on Budgetand Policy Priorities.

These direct-enrollment broker websites — includingeHealth, ValuePenguin, GetInsured.com and some named after theinsurance carriers they represent — are not the state-basedmarketplaces or the federal exchange, known as healthcare.gov.

The commercial sites promise more options to consumers shoppingfor health insurance. They can offer Obamacare plans, for instance,as well as lower-cost but less comprehensive plans, such asshort-term policies and other types of coverage that don't meet thefederal Affordable Care Act's requirements.

About 42 percent of enrollments for 2018 ACA plans were arrangedthrough sales agents or brokers, with many of them relying on suchalternative websites to enroll their clients, noted the report.

But consumers who use alternative portals, the report warned,don't have the same shopping experience as applicants accessingstate or federal marketplaces. That's because government sites mustprovide full information on all available ACA choices and cannotsteer consumers to non-ACA plans. The government marketplace alsois responsible for accurately processing applicants' eligibilityfor Medicaid or premium subsidies. The commercial sites generallydon't have those responsibilities.

Two years after sharp financial cuts by the Trump administrationfor enrollment outreach and funding for navigators and otherassistants helping people sign up for ACA plans, the administrationencouraged consumers to seek out brokers for help.

For next year's enrollment period, it is considering changingthe rules to allow federally funded navigators to also use thealternative websites to enroll consumers.

There are differences among the alternative websites. “Not allentities have these problems,” the report concludes. “But theprogram lacks safeguards to protect consumers from harm.”

It found that some direct enrollment websites:

• Use default settings, chat boxes and other design methods tohighlight alternatives that earn the web brokers highercommissions, such as low-cost, short-term insurance plans, whichcover less and can reject people with preexisting conditions.
• Either fail to inform or provide inaccurate assessments ofwhether applicants or their family members might qualify forMedicaid or premium subsidies to help them get coverage.
• Fall short of providing full information on premium costs anddeductibles for all the plans available in a region.

The commercial websites are “under-policed,” said report authorTara Straw, a senior policy analyst at the center.

The administration, she said, should more closely monitorwebsite design and how well the sites inform consumers of theirpotential eligibility for government assistance in purchasingcoverage.

Because of the drawbacks, consumers who use some of thesewebsites are at a disadvantage, lacking the ability to adequatelycomparison shop, the report warned.

As a result, some may choose non-ACA plans, such as short-terminsurance, which may not be their best option. Others may bediscouraged from applying for coverage at all if the websitesinaccurately indicate they might not qualify for a subsidy orMedicaid.

“That's the problem,” said Straw. “The websites can say, 'We'retelling people to complete the application [to assess subsidyeligibility],' but who is going to do that when they're showing allthe plans at the unsubsidized price?”

Comparison shopping on some of the websites is limited.

An example outlined in the report focuses on Duval County, Fla.,where the eHealth website shows a list of ACA policies described as“17 of 17 plans” available. Each of those 17 shows the costs ofpremiums, deductible amounts and other details. At the bottom ofthe screen, however, eHealth lists the names of 32 additional plansavailable from Florida Blue, the state's largest insurer, withoutany specifics on cost and coverage.

If consumers stopped there, they would not know that on FloridaBlue's website they could find 15 plans that are less expensivethan the lowest-cost plan listed on eHealth, according to thereport.

“Without visiting multiple websites, consumers would havedifficulty finding and comparing their plan options,” the reportsaid. “This is the type of fractured shopping experience themarketplace is designed to remedy.” It noted, however, that one webbroker, HealthSherpa, did list all 49 plans available in DuvalCounty.

An eHealth spokeswoman countered that the website makes it easyfor consumers to get additional information on available plans itmay not sell directly.

“When they get to the bottom of the page, they see 32 additionalplans available through the federal marketplace, with a hyperlinkdirectly to that marketplace,” said eHealth's Lisa Zamosky.

To avoid having to visit multiple sites, Straw offered consumerssimple advice: “Go to healthcare.gov.”

Kaiser HealthNews (KHN) is a national health policy news service. It is aneditorially independent program of the Henry J. Kaiser Family Foundation whichis not affiliated with Kaiser Permanente.

Read more: 

• New 'super broker' system cuts HealthCare.gov outof the ACA signup process
• Consumers' online searches for ACA plans led moreoften to short-term plans
• ACA enrollment declines greatest amongnon-subsidized plans