INSURANCE SANTA MARIA

Health Insurance Agents – What Are They Good For?

If you are in the market for an individual, group or senior health insurance plan, you have 3 options:

1. Contact an insurance carrier (a company such as Blue Cross, Blue Shield, Aetna, Health Net, etc.) directly,

2. Use an online search engine to find health insurance yourself via the Internet,

3. Locate a local health insurance agent or broker to assist you.

Here are some things you should know about each option. For the purposes of this article, let’s assume you are looking for an individual or family health insurance plan.

1. Call an insurance carrier or go online to their website: Advantages – You are communicating directly with a company you may want to insure you; they will know their plans very well, and can show you how to apply. Disadvantages – They can only discuss their own plans and therefore cannot help you compare theirs with other companies’ options; their interest is in finding the healthiest of potential enrollees and what’s in their interest is not necessarily in yours; they may answer your questions pre-enrollment, but will not offer much personal post-enrollment support; while you might think that purchasing directly from the insurance company will provide you lower premium costs, you will pay the same amount as you would if you went through an insurance agent.

2. Use an online search engine to find health insurance yourself via the Internet:

Advantages – An online website may provide you with an online quoting system that can offer you a convenient and effective way to compare different plans from different companies; they might possibly offer some pre-enrollment support through an 800 number so you can ask questions you may have. Disadvantages – Most of their investment has probably gone into advertising on the web so that they can attract you to their site; you will likely get minimal pre-enrollment support, and usually zero post-enrollment support; also, many of these companies work in numerous states and won’t necessarily know the plans in your county; the company behind the website becomes your broker but typically provides nothing once they have signed you up.

3. Locate a local health insurance agent or broker to assist you:

Advantages – A licensed independent health insurance agent or broker can assist you – in person, by phone and/or via the Internet – in comparing some 125 different individual and family plans from California’s major insurance companies; because there are various plan structures (HMO, PPO, HSA) and a dizzying array of copayment, deductible, coinsurance and out-of-pocket maximum options [to be discussed in a future article], a competent agent can help you prioritize your preferences and determine which combination of benefits and plan costs will best suit your needs and fit your budget. A good agent can clearly explain how the plans work, including their strengths and weaknesses, and answer your specific questions, provide guidance on how to correctly complete the paper or online application so that you are more likely to get approved, as California law presently allows insurance companies to decline to cover you, or charge you more money, if you have certain medical conditions – and so wording becomes very important; the agent will know which companies are more apt to accept you with specific minor conditions, and should be able to advise you on your alternatives if you are apt to be declined. Once you are enrolled in a plan, an agent and their agency can offer you post-enrollment support beyond what the insurance company will provide – such as assisting you with insurance billing problems, intervening on your behalf if certain medical procedures or charges are denied by the insurance company, and helping you to find other coverage if and when your personal circumstances change – or if the premium costs are raised inordinately. Perhaps the biggest advantage of working with an agent is the fact that the value-added services described in this section cost you nothing – since you pay exactly the same premium whether you work with an agent or you don’t. Disadvantages – It is up to you to do the research necessary to find an agent who can meet or exceed your expectations; as in any field, there are varying degrees of professionalism among agents – in terms of the depth of their expertise, the ability to clearly articulate the differences between plans and companies, how much time they are willing to spend with you and how patient they are, whether they are out to make a quick sale or if they really have your best interests at heart, as well as the kind of ongoing customer service they are willing to provide. Don’t be afraid to consult with several agents if you are not comfortable with the first one you speak with, and trust your instincts – they’re usually right.

Much of what is written above also pertains to health insurance for companies, and for seniors who want to supplement or enhance what Medicare provides them, even though some of the rules are different.

Since the price of each health plan is the same regardless of which of the 3 methods you use as described above, you need to find the best source of knowledge to help you determine which plan from which company will best meet your needs. You may have heard about the concept of a "Health Insurance Exchange," currently being discussed in Congress as part of a health insurance reform package, where you will be able to easily view a multitude of options available to you. The good news is that this concept already exists – in the office of a local health insurance agent near you – and on their website! Visit http://www.insurancesantamaria.co for more information.