Make your health insurance broker a translator, not a buyer

In the endless ocean of medical insurance choices and complexity, navigating your own boat is harder than it looks. Especially when you get a new job, get old in Medicare, or turn 26 and therefore can’t stay on your parents’ coverage. Every ship’s captain needs a helmsman – brokers are a major help in choosing a health plan, but they’re best used as an insurance translator rather than your personal shopper. Learn the ropes of health plans from brokers, but don’t let them hijack your decision-making. Ask them to announce what awaits them from the crow’s nest while steering the steering wheel yourself.

You may hear people refer to broker and healthcare agent interchangeably. This is a major point of confusion for many patients. Health insurance agents have agreements to promote and sell one company’s plans. Although a company like United Healthcare has many plans under its umbrella, agents have no incentive to suggest alternatives that might serve you better. Brokers can partner with as many companies as they wish. Most brokers specialize to some degree. For example, a broker can only help patients enrolled in Medicare. You don’t pay these people directly anyway. Both types of health care purchasers themselves receive commissions from insurance plans. Although more and more independent brokers are choosing to be paid only by insurance buyers, these offers are generally designed for larger clients.

The economics of selling health plans is the biggest downside to hiring a client, whether you’re a patient or an employer. Firms incentivizing brokers to offer certain plans seem fine on the face of it, but there is a transitive property here. Insurance plans remunerate brokers, and these commissions flow directly into insurance premiums. Then employers (and, by extension, you) pay those higher premiums. Agents who only represent one insurance company also tend to receive other bonuses. Even brokers offering dozens of plans may charge large clients separately for specialized advice. A rational broker offers them plans with the highest bonus. This is a simple conflict of interest similar to the old days when drug companies offered overt bribes to doctors prescribing certain drugs. Employers and patients will not know insurance price breakdowns unless they ask. So ask for the fee schedule of the person you hire. The quotes for the health plans themselves aren’t definitive to begin with, since most companies say their estimated premiums are “representative.” You only discover an actual cost once the formal insurance application and underwriting is complete. Being aware of this bias allows you to keep the broker as an observer rather than a shooter.

Whether you are a beginner or an experienced buyer, you need more than a quote. Because there are so many plan choices, your broker should make simple side-by-side comparisons. The tasks of health insurance buyers are not complete after purchasing coverage. Agents should help you with renewal and customer service as needed. If you get a plan from a company like Aetna, be sure to get contact information for the corresponding service representative who can answer your questions about billing and coverage. If this all sounds complicated, that’s because it is – there’s a reason brokers have jobs. Buying insurance is complicated enough that major exchanges have people called browsers. They’re like agents, but they’re paid for by state and federal grants instead of insurance companies. Navigators aren’t required to be licensed in any particular state and can’t promote one health plan over another — they’re like the staff at the mall or hospital information desk. Browsers are just another layer of healthcare bloat. Better to have a knowledgeable but biased agent than a navigator. Better yet, enjoy the Internet. Use website solutions like health insurance company pages, broker platforms, and buying alliances, so you don’t have to rely solely on your broker to keep up with all the regulations.

Source: eHealth

Even with misaligned incentives, brokers are helpful in guiding you through the foreign language of health insurance. A number of Americans still don’t know what a deductible and maximum payout are. A broker can help you bridge this gap in insurance knowledge. Don’t rely on them too much – remember they are fighting for the health plans money, not yours. Nothing prevents you from going it alone as long as you have a clear idea of ​​your needs. Ask yourself: how often do you need to see GPs and specialists? How attached are you to your current suppliers? Do you take prescription medication? Are these drugs branded? Do you have a budget and need to add people to the insurance? Let your broker participate but don’t dominate the discussion on these factors. You are effectively increasing the cost of your final health plan in exchange for personalized advice. What matters is that you know that this compromise exists. Let this knowledge put you in front of other patients and employers. Let them do their job if you choose a broker or agent. Follow the recommendations in stride, but be aware that no type of insurance buyer can represent you. You or your employer are the final arbiters of which plan to use. A broker simply translates your choices into plain language. Stay focused and make sure that’s all your broker is doing.

Rushi Nagalla is co-founder of a dermatology practice.

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