Cigna will be withdrawing from all Marketplaces in 2027. The expiration of enhanced premium tax credits has consumers questioning whether they can afford any coverage. And recent estimates (though the government has yet to publish actual figures) suggest that the Marketplaces have shed about 5% of their overall membership.
So, we wouldn’t blame you at all if you looked at all this news and said, “Gosh. There’s no future selling Marketplace products.”
But we would disagree with you.
At least Cigna got its announcement out fairly early. Even so, a quick tour around social media tells you just how anxious consumers get when these things happen. They want to know their options, when they’ll be able to make a plan change, and whether their doctors and drugs will be covered on any new plan.
Our Michigan agents likely aren’t severely impacted by Cigna’s exit. But, the writing is on the wall: It’s entirely possible we’ll see carriers of all sizes step out of the Marketplace in the coming months and years – even as governments try and incentivize them to stick around.
So, when (not if) an exit affects your book, you’ll need to think about how to calm customer nerves.
That will likely require phone outreach to any impacted client. They’ll need to know:
If the carrier plans an end-of-year exit, consumers likely can’t start shopping until the fall OEP. But even then, sharing an alternate quote that shows where their doctors and drugs can be covered can go a long way toward letting them know you’ve got their backs.
That creates a stronger business relationship – and an opportunity to show you will take care of them during enrollment season.
The most recent enrollment numbers tell us that about 40% of all Marketplace enrollees have a bronze plan. In light of the enhanced subsidies disappearing, those folks seek the lowest available premium. But that also means they’ll have the highest available deductibles and out-of-pocket maximums – often, those figures will be the same.
If recent history is any guide, the average family contract will need to pay the first $20,000+ of their healthcare expenses in 2027. All that, on top of their premiums.
As an agent, your job shifts from “find the lowest premium plan that takes your clients’ doctors and drugs” to “build a benefit package that protects your clients from financial ruin.”
Supplemental health products – critical illness, hospital indemnity, and accident -- will be key.
Of course, any extra protection will cost an additional monthly premium. But paying $30 a month to offset a $20,000 deductible is better than having to come up with that money out of pocket, and all at once.
There’s no way around it. Some folks will simply be priced out of the Marketplaces – even for the catastrophic plans. And, some of your clients, especially recent immigrants, will fall victim to tightening requirements, forcing them to seek a new route for coverage.
For these clients, ACA alternative plans, including short-term plans, could be an option.
ACA alternatives are often medically underwritten; they’re a good fit for your healthy clients. For full major medical plans, the coverage often mirrors what you’d see on an ACA-compliant plan. However, the medical underwriting allows them to exclude bad risks and help keep premiums lower.
Mini-medical plans are also an option. While they’ll often exclude pre-existing conditions for a period of time, there is typically less underwriting involved. The trade-off, though, is the coverage limits – either lifetime benefit maximums, yearly service maximums (e.g., only three specialist visits per year), or both. That’s where those plans are able to deliver premium savings – but again, they’re only a good fit for those who won’t use care often.
Finally, short-term medical plans are also an option. Here, too, you’ll find exclusions for pre-existing conditions. And, you likely won’t find drug coverage. But for a relatively healthy client who wants protection from the absolute worst occurring? It’s an option.
Any or all of these plans can be stacked with a supplemental policy to help fill their gaps – mini-meds are well-complemented by a suite of accident, critical illness, and hospital indemnity plans, for example.
Where there’s uncertainty, there’s opportunity. You have plenty of opportunities to show up for your ACA clients in the next several months: opportunities to show up with a guiding hand, a comprehensive benefit package, or alternate paths to coverage. Taking advantage of any of those opportunities puts you in a better position to serve them – and in a better position to be profitable in individual and family sales.