Narrow networks and consumer confusion seem to top the list of reasons why many uninsured Americans obtained coverage off exchanges for 2014, according to benefit advisers.

While the Affordable Care Act envisioned most uninsured Americans enrolling for insurance coverage through the health care exchanges, nearly half of the newly insured signed up off the exchange.

Overall, 11.8% of U.S. adults say they got a new health insurance policy in 2014, a recent Gallup poll finds. One-third of this group, or 4% nationally, say they did not have insurance in 2013. A little more than half that group, or 2.1% of the U.S. population signed up for health insurance through the public exchanges, yet nearly half (or 1.9% of the U.S. population) signed up elsewhere, including through employee policies, Medicaid and other private policies not arranged through exchanges, Gallup says.

J.J. Flotken, partner with St. Louis, Mo.-based employee benefit firm Caravus, says a lot of the off-market interest in his area has been due to the limited provider networks offered through the public exchange.

“With a consumer having a choice between a marketplace product that has a limited provider offering and a private insurance market product that gives them flexibility beyond that scope, we’re seeing people choose the latter,” he says.

Confusion in the marketplace has also driven consumers away, Flotken adds. “A lot of people just don’t understand how the marketplace works or how to access it and are more apt to go through traditional channels.”

Joe Torella, president of employee benefits at Hub International Northeast, agrees. “The process for enrolling is difficult and while the coverage options available match available private offerings, the networks are typically different,” he says. “Therefore it’s a more complicated set of steps that have to be followed and a more complex decision-making process.”

More consultative

Back in Flotken’s market in St. Louis, he says employee benefit advisers have taken the various options between the exchange and off-exchange to work on a more consultative basis and guide individuals toward the plan that best fits their needs.

Without complete data on enrollment numbers and the newly insured, it’s still too early to tell the number of enrollments on or off the exchange handled by benefit advisers, but “the anecdotal evidence is that agents and brokers played a significant role in pushing exchange enrollment above the original projection 7 million people,” says Ronnell Nolan, president and CEO of Health Agents for America Inc.

“In addition to the millions of Americans who enrolled for coverage through HealthCare.gov, insurance agents and brokers also helped enroll untold numbers of people through off-exchange individual and group coverage as well,” Nolan says.

See related: Agents write considerable business on ACA exchanges

Now that the enrollment window has closed, she adds, benefit agents and brokers have the opportunity to demonstrate the value they offer consumers every day in understanding their benefits and assisting with any problems that should arise.

Gallup also said recently the uninsured rate dropped more in states that embraced the ACA by expanding Medicaid and setting up their own exchanges in the health insurance market. The uninsured rate, on average, declined 2.5 percentage points in the 21 states (plus the District of Columbia) that have implemented both of these measures, compared with a 0.8-point drop across the 29 states that have taken only one or neither of these actions.

The newly insured are also on average, much younger than the overall population, with most younger than age 65. Within the 18 to 64 age range, the newly insured are slightly more overrepresented in the 18 to 29 age category than in the 30 to 49 and 50 to 64 age categories.

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