Since the insurance marketplace began open enrollment Oct. 1 — providing affordable insurance to mainly uninsured residents — federally funded navigators across the state have helped consumers understand their options and find the plan that best fits their needs. Private insurers participating in the marketplace have also had their own agents out, specially trained to help consumers. However, unlike their federal counterparts, these agents only discuss the plans offered by their companies, according to insurer representatives. Meanwhile, insurer and marketplace participant Blue Cross Blue Shield dominates almost 90 percent of Alabama's insurance industry.
The situation adds up to fewer competitive insurance choices for Alabama consumers — a contrast from what the marketplace was intended to be, some health experts say.
Sabrina Corlette, a research professor and project director at the Health Policy Institute at Georgetown University, said there is nothing nefarious about private insurers navigating consumers to just their plans in the insurance marketplace. However, the practice means some consumers might not see all their options before picking a plan.
"Consumers need to understand that if they want to effectively compare options, they need to go to a federal website or a federal navigator to do that," Corlette said.
The insurance marketplace, part of the 2010 Affordable Care Act, offer various health plans from private insurers, the costs of which will be supplemented by tax credits for people at certain income levels. Some states will run their own marketplaces while others, including Alabama, opted for a federally run program. In addition to Blue Cross, only private insurers Humana and United Healthcare are offering plans in Alabama's insurance marketplace. Residents can contact an area navigator to help them enroll or enroll directly through Healthcare.gov. Coverage begins Jan. 1 in the marketplace.
Corlette said increased choice is a major part of what makes the marketplaces effective.
"The whole notion behind the marketplaces is to encourage the insurers to compete on price and value — with shoppers voting for the best ones with their pocketbooks," Corlette said. "If consumers are just getting information from one insurance company, it kind of defeats the whole purpose of a marketplace."
The lack of insurance plan options in Alabama compared to other states is striking. According to the U.S. Department of Health and Human Services, Alabama has the fewest plan options among the 36 states with federally run marketplaces. The HHS report shows Alabamians are able to choose between seven different marketplace plans on average, depending on where they live. In contrast, Georgia residents have 50 plans to choose from on average. Florida residents have 102 while Tennessee residents have 59 on average.
Of the three insurers offering plans in Alabama's marketplace, only Blue Cross is providing them in all 67 counties. Also, earlier this week, Blue Cross announced it has partnered with Alfa Insurance, allowing agents from both companies to help navigate through health plans on and off the marketplace.
"Blue Cross and Alfa agents will be offering Blue Cross' individual health and dental plans to consumers," said Koko Mackin, spokeswoman for Blue Cross.
Mitchell Lubitz, spokesman for Humana, said agents from his company will also be pushing Humana health plans in the marketplace.
"We have trained a broad network of certified health insurance brokers ... we also plan to have Humana representatives in various retail outlets in Alabama to help answer consumers' questions," Lubitz said. "Humana sales representatives are licensed to help prospective Medicare and individual health insurance members and customers understand their Humana plan options."
Jim Carnes, spokesman for Alabama Arise, a non-partisan group that advocates for low-income residents, said private insurers pushing their own plans in the marketplace means some people might have fewer choices or options. But what makes Alabama's marketplace even more devoid of choice is Blue Cross' dominance.
"They're the only ones selling plans in all the counties ... the whole idea of the marketplace is to foster competition," Carnes said. "Even though here at the beginning, Alabama's federally facilitated marketplace wasn't structured for competition ... we hope more insurers will come in over time."
Meanwhile, Anniston has just one paid federal navigator who must also cover the surrounding eight-county region. Anniston also has a similar federally funded navigator-type professional called a certified application counselor, who is provided by Anniston Quality Healthcare, a community health center.
The federal navigator is under the jurisdiction of Enroll Alabama, a nonprofit established with federal money to help educate state residents about the marketplace. Sonja Smith, project coordinator for Enroll Alabama, said her organization is trying to expand its reach and is training about 90 volunteer navigators. Smith said the extra navigators are a necessity.
"Interest is still pretty strong in the marketplace enrollment," Smith said. "We're still getting lots of calls and different social service agencies are still asking us to come out and hold information sessions."
Dr. Mike Morrisey, director of the UAB Lister Hill Center for Health Policy, said that a consumer who discusses the marketplace with a private insurance agent might not see all of his or her options. However, a consumer who just discusses the marketplace with a navigator might not learn about all options, either.
"The insurers are selling plans both inside and outside the marketplace, while the navigator is only showing options inside the marketplace," Morrisey said. "They might not have the best option for some consumers on the marketplace ... the identical plan might be cheaper outside than inside ... so there is a limit on both sides."
For more information about the marketplace or to request help with enrollment, call 256-235-1028 or 205-305-6506.
Staff writer Patrick McCreless: 256-235-3561. On Twitter @PMcCreless_Star.