Is Health Sherpa scam a thing? Considering that unclear policies and process administration might deprive the poorer consumers of the best fitting healthcare insurance solutions, it just might be. Direct Enrolment entities like this web broker have assigned themselves to distribute affordable healthcare products and services per the ACA. However, pending the further streamlining of application processes, a vigilant consumer ought to keep his eyes peeled. He does not want to be led to a sub-standard healthcare insurance plan, like a number of Direct Enrolment entities have been found to have done.
A Cavalier attitude to transparency
Health Sherpa is merely exploiting all loopholes in the ‘Enhanced Direct Enrollment program to enrich themselves at the expense of less well-off clients.
Merely a web broker
Natural Health Sherpa does not provide complete information about its own goals on its own website. The name is also conflated with the name of another entity that grabbed the attention of policy analysts nationwide. Whose fault is it that the two names are easily confusing? Are Natural Health Sherpa and Health Sherpa of ACA fame, the same entity?
Leaving aside the nit-picking, we will demonstrate how it has made affordable healthcare insurance a needlessly complex affair for less endowed families.
The Affordable Healthcare Act or ACA set up healthcare insurance marketplaces to behave as a single point where consumers could compare healthcare plans on the basis of quality and price and apply for financial assistance. All marketplace plans were intended to meet a regular set of standards:
- They cover a basic set of benefits.
- Health status or gender based premiums are not permitted.
- The info display has to be impartial to aid consumer decision making.
Consumers were envisioned as being able to submit one application at the marketplace website, connecting with the health coverage type they are eligible for, regardless of if it’s Medicaid, CHIP or the Children’s Health Insurance Program, or a private plan.
Health Sherpa separates the consumer from the marketplace.
However, today, many consumers use websites other than the marketplaces to get enrolled in marketplace plans and apply for ACA subsidies. Via a federally created pathway called ‘direct enrollment’, insurance companies and web-based brokers began using their own websites to assist people in enrolling in marketplace plans and accessing subsidies. Then there came the ‘enhanced direct enrolment’ pathway, permitting insurers and brokers to assist people in enrolling in marketplace plans and taking care of the whole application process.
It is wanting in the benefits and protections that the ACA marketplaces proffer.
Health Sherpa offers non-ACA compliant plans
The web broker ofes plans that are incompatible with ACA standards. They might actually stand to gain financially if they were to enrol more folk on dubious grounds. It offers short term health plans and other plan types that do not fit in with ACA consumer protection standards. Conversely, Health Sherpa pays a high commission to agents and brokers. Federal rules prevent Health Sherpa from displaying these plans besides marketplace plans, but it has been known to shift consumers away from marketplace options with screening tools.
Medicaid eligible folk may encounter further barriers to enrolling when with Health Sherpa.
The marketplace has a ‘no wrong door policy, implying that going to the marketplace website can complete one application and be routed to Medicaid, marketplace subsidies, or CHIP(medical device alert) on the basis of info they proffer. Health Sherpa has been known to waylay consumers so that they go astray from the marketplace application process, having not informed them they might be eligible for no-cost coverage or by manoeuvring them towards non ACA products.
Health Sherpa obstructs competition amongst private insurers.
Health Sherpa prevents consumers from engaging in full comparison of private health plans on the basis of quality and price, which slows down the competition between insurers. Not similar to marketplace websites that permit people to compare all eligible health plans in great detail, Health Sherpa may not present all available marketplace plans or comparable plan information. Who’s to say that Health Sherpa does not have financial incentives to steer consumers to specific insurers. Health Sherpa thus makes it close to impossible for the little guys, or new entrants in the insurance industry, to compete.
Direct Enrolment institutionally hampers consumer protection.
Health Sherpa shares these shortcomings with a host of other ‘Direct Enrolment’ entities. As things stood at the beginning of the Trump administration, Direct Enrolment entities, including Health Sherpa, posed an actual risk to consumer health. Ameliorative measures are beginning to be taken by the Biden administration. The proclivity towards rampant privatisation will now be more moderate. We can thus hope for a gradual expansion of the marketplaces’ resources, capacity, and public presence.
Pending reform, Health Sherpa still open to gross exploitation
The new administration has to further streamline the operations of Health Sherpa and other Direct Enrolment entities. We are tempted, therefore, to issue caveats against the following.
There’s none to stop Health Sherpa from selling short term health plans, fixed indemnity plans, and healthcare sharing ministries. More often than not, non ACA plans such as these are against the consumer’s best interest. Health Sherpa could still reject or charge higher premiums to people with pre-existing conditions; charge in excess on the basis of gender, age, or such factors; impose annual and lifetime benefit limits; demand cost sharing of any amount; omit ACA essential benefits.
Possible abuse of consumer info
There’s every possibility that beyond the initial enquiry, consumer info may be used still further. So what’s to stop Health Sherpa from forcing a consumer to consent to a disclaimer, stating that the latter is open to marketing calls and messages from the broker as well as allied partner companies?
It’s not known if Health Sherpa gathers and sells browser tracking data.
The features every good health insurance company offers
Health Sherpa is a web broker. It does not pretend to be otherwise. Nevertheless, there’s a good deal of conflation between offering and withholding of info and services to the extent that some erroneously believe natural health sherpa is a healthcare insurance provider. Has this been done intentionally? Clear cut instances of best healthcare insurance providers include
- Kaiser Permanente;
- Blue Cross Blue Shield;
- Molina Healthcare.
The features every good health insurance company offers
- Excellent wellness program;
- Excellent preventative care;
- Out of network healthcare available without a referral;
- Telehealth services;
- Nationwide coverage;
- Wellness programs;
- Large PPO network;
- Online Healthcare services;
- Variety of health plans;
- Health savings account options.
Without a doubt, Health Sherpa started out as a bona fide web broker of ACA compliant products and services. Unfortunately, less endowed consumers may be led right up the garden path due to policy oversights and biases. Is this true freedom if they do not have the freedom to assess what they are being handed over? Though we are unhappy to anoint these errors as ‘Health Sherpa’ scams, it would be equally misleading to term them peccadilloes. In the interest of the poorer consumers, steps encouraging more transparency have to be ensured at Health Sherpa and across the board with the whole body of Direct Enrolment entities.
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