Platinum Group Blog Header


Do I need a Health Insurance Agent?

by Kelly Rose / November 17, 2015

For many individuals and employers Health Insurance is a topic that you once tried to avoid. Now that we have mandates and qualifications through the Affordable Care Act, the once gray areas have become even darker and harder to navigate. Having a trusted agent on your side can ease the burden and bring much needed light to the new framework of Health Insurance.

Health Insurance Literacy Matters

The Affordable Care Act (ACA) significantly improved the health coverage shopping and enrollment experience. However, health insurance policies, terms, and concepts remain incredibly complex, and substantial gaps in knowledge about health insurance remain, which result in buyer’s remorse, improper utilization of health care services, and/or loss of coverage completely.

The goal is for the uninsured to get covered and stay covered. While many individuals may see the value in Health Insurance, there will continue to be some that don’t.

Consider the following as examples:

In 2014, with help from a tax credit, Seth enrolled in a marketplace plan for $84 per month with a $6,300 deductible. Mark picked the plan with the lowest premium in his area. However, he did not know that he should also look at the amount of the deductible, and he later learned that his prescriptions were not covered until after his $6,300 deductible was met. With his income sporadic and seasonal, it was difficult to afford his premium and the cost of his prescriptions entirely out of pocket before the deductible. He stopped paying premiums mid-year and did not see the value in paying for something he could not use right away. Mark did not enroll in coverage for 2015.

On the other hand, Valarie purchased a marketplace plan with a premium of $73 per month and a $0 deductible, also with the help of a tax credit. Valarie sees a dermatologist every six months and is interested in seeing a therapist. Valarie is a full-time graduate student, and with only a part-time job, she could not afford to pay a lot out of pocket for a specialist doctor visits. With help from an experienced agent, she selected a plan with no deductible that covered the services she needed and created a monthly budget to figure out what she could afford. During the year, Valarie received guidance and support from her agent on how to successfully utilize and understand her health care plan. The majority of her mental and physical health care was covered in 2014, saving her money over the course of the year. In December 2014, Valarie knew that she needed to go back and meet with her agent to explore her options during open enrollment because of the emails and reminders that she received from her agent. Valarie was able to update her application and choose a new plan that would meet her health care needs and budget for 2015.

The Value of an Agent

  • Working with an agent is FREE! There is never an additional charge to work with an agent and it does not change the cost of your health insurance premium. 
  • Agents are licensed and trained to know the ins and outs of the Affordable Care Act and how it effects individuals, families, and employers.
  • Discussing the details of your income and household information with an agent are kept confidential and are only used to help determine which plan may be best for you and your family. Your personal information is never shared or sold.
  • Employers need a trusted adviser and strategic partner to guide them as they are choosing the best plan for their employees. This includes coverage and affordability.
  • The terms and concepts of health insurance plans are best understood by educated and experienced agents.
  • Agents provide support and guidance throughout the year. Even after Open Enrollment is over there may be issues that arise with the Healthcare Marketplace or the insurance carrier that you choose. Your agent can assist you with handling these matters.
  • Did you have a change of income? Your agent knows how to correctly update your application and explain how your premium tax credit and health plan may be effected going forward.
  • If you experience a major life change, such as a marriage, having a baby, or losing health coverage through an employer, agents can assist you through those Special Enrollment periods.

If the Affordable care Act, Obama Care, or the Health Insurance Marketplace — however you may refer to it — is overwhelming and confusing, you’re not alone. Many individuals, families, and even employers, reach out to educated and experienced agents for help.

Platinum Group is a full service human capital management (HCM) resource that allows businesses to manage their payroll, benefits compliance, track time and attendance and other various human resources functions in a way that maximizes efficiency and eliminates redundancies with the platform, iSolved. For more information about Platinum Group or to schedule a demo of iSolved please visit our website.

Customize Your Appointment


Tags: Insurance-Individuals

previous post Top 10 facts about 2016 Health Insurance Open Enrollment
Next Post FLSA Lawsuits - Top 5 things investigators review