This time of year during Open Enrollment, it gets a little crazy for brokers. We only have 6 weeks to enroll a large portion of people in the USA in the Affordable Care Act plans, so it takes a lot of time and energy to service everyone who asks for our help. I hope that this article finds a lot of people, so they can better understand the things that us as brokers already know. After reading this article, you should have a better understanding of why I choose certain products for you, or do certain things to build your insurance plan.
I’ve been a broker for a while now, and I love every second of it! I’m learning new things every day and adding them to my repertoire of knowledge. The more knowledge I obtain, the more I distance myself from the general public that might not know as much about insurance as I do. With this contemplation in my head, I realize that I need to make sure that the general public is let in on some of that knowledge. I want them to also benefit from understanding WHY a certain insurance product or service is included in a plan, and how to fully protect a person from the dangers of this world.
Below are five things that I wish you knew.
My Services Are Free
When insurance brokers get licensed, they also get contracted with a lot of different insurance companies, or “carriers” – including the federal government. These carriers are the ones that pay insurance brokers when they enroll a new individual. So if you buy an insurance plan through me, I get credit for enrolling you which turns into payment for my efforts to service your account. This allows our services to be offered to the general public at no charge. There’s no upswing, no hidden fees, or sneaky price hikes that happen at the last possible moment. In the insurance world, there’s no budging on the prices; they are what they are and that’s it. So if you’re worried about an insurance agent like me hiking the price up for my services… well that’s just impossible!
Have you ever heard the phrase: “Nothing worth having comes easy”? Well that’s so true when it comes to the Affordable Care Act! For some people, the Affordable Care Act (ACA) is a lifesaver! If you qualify under the income requirements for your household and receive a discount on your insurance, you could be looking at a very affordable plan. But, as I think all of us already know, is that any time you deal with the federal government, it’s going to a little sluggish. The DMV, Social Security office, etc. I’ve waited at the Social Security office for over 4 hours before – and it was the one time I forgot to bring a book. Can we say BORING?!
With the benefit of being eligible for a discount, it also means that the government is going to want to prove that you deserve to have that discount. You usually prove that through providing proof of your income for that year. This means that you cannot lie and say your income is less on your application, because they will find out!
Once you have this proof of income, the government will process it which usually takes 4-6 weeks, sometimes sooner. During this time that the government is processing your information, you will not be able to use your insurance. If you try to go to a doctor during this time, the doctor’s office will treat you like a cash customer. They will ask you to pay the cash price even though you just signed up for insurance. Once you have been fully accepted, and the government has sent your information over to the insurance company, then you will have insurance. This means there could be a time period where you feel like you don’t have insurance. You actually do. Once your plan is accepted, the insurance company will retroactively cover the bills you may have had if they were right after you enrolled.
Another complication to be aware of involves your children – if you have them. Some states, depending on your income, will want to enroll your children in various programs, like CHIP, Medicaid, etc. When that happens, they “don’t have insurance yet” like I said in the last paragraph, until that individual insurance program accepts them. So just be aware… if you have a medical emergency right after you enroll, it’s not going to be fun to pay out of pocket until your insurance pays you back.
Don’t Procrastinate Enrolling
Six weeks goes by VERY FAST! If you’re not careful, you could miss it. Missing it means you won’t be able to enroll again in a plan for an entire year. You’ll have to have a specific circumstance like getting married, divorced, death in the family, or moving, etc. Missing that window means that the only other way to get insurance to cover your pre-existing conditions is to get a job with benefits and wait for them to kick in. I wish you could see what it is like during the last week of Open Enrollment! It’s a mad house! All the procrastinators are calling into get their application in on time. The last few days, I will be in the office until midnight guaranteed, helping ask as many people get enrolled as possible before the cutoff.
Another reason to not procrastinate and call me now to schedule and appointment, is because if you and I run into any snags on your application… where we need to revisit it later, or find some information, or simply miss each other before the application is submitted, it could cause disaster if the deadline is missed. What I say is, better be safe than sorry!
It’s Not For Everybody
The misconception with the Affordable Care Act, is that it’s the only insurance that’s available out there, and that you’re stuck choosing a plan even if you don’t like any of them. The world of health insurance is much bigger than just the ACA. Outside of that, you have what they call “Short Term Medical” policies. Funny thing is, they are no longer “short term”. Your ACA plan lasts for a year and then needs to be renewed, and your Short-Term Medical (STM) plan also lasts for an entire year. There are several reasons why the Affordable Care Act might not be a good fit, and you may be better suited choosing an STM policy from an independent insurance company. Some examples of reasons would be if you are 100% healthy with no pre-existing conditions, or if you make too little or too much money for the ACA.
These are the most common examples. The truth is sometimes NOT going with the ACA is your best bet. If you are sick, or have had a pre-existing condition in the last 5 years, pregnant, or have really expensive medications then you definitely want the ACA. Short-Term Medical policies don’t cover pregnancy/delivery, pre-existing conditions, or current illnesses. The plus side for going with a STM plan is that the price can be half the cost, if not exponentially less. Since the private companies aren’t covering pregnancy and pre-existing conditions, their rates are able to stay very low and competitive. You would be surprised what some of them are compared to what the ACA offered you. There are a lot of reasons to choose one over another, too many variables to answer in a blog post. That’s why the general public puts their trust in brokers.
Sometimes the Affordable Care Act Isn’t Enough
I wish the general public understood the details of health insurance like I do. Nine times out of ten I know what’s best for them and have created a plan that protects them and their family the way it should, and the client keeps shaving off services to save money. Reason this concerns me, is that it leaves them exposed. Typically, just having the ACA as insurance won’t be enough to really help you in times of need. Affordable Care Act plans typically have gigantic deductibles (and no real benefits until you pay it off), no accident protection, no protection in case you get a critical illness, no dental or vision, and not any help to reduce the big hospitalization costs if you get admitted.
Best case scenario for us as brokers when we are working to protect your family, is to bundle an Affordable Care Act plan with what they call “supplemental” insurance policies. Adding accident protection for example, will reduce your max out of pocket from something around $7,350 all the way down to only $250! Another example – If you get hospitalized for 3 days and the bill is $20,000 then that means you have spent $7,350 out of your own pocket (because that was your max). There’s a product out there that I have nicknamed “The Bill-Shrinker” because it will help you pay down your bill by reimbursing you anywhere from $1,000 – $4,000 per day you’re in the hospital.
The reimbursed money will pay for the entire max out of pocket, and you will have little to none bills to pay. Affordable Care Act plans do not have this feature. There’s a lot of variables that go into this, so don’t feel like you “have to” choose one plan or another to have the best insurance. We as brokers are very knowledgeable,
and are able to customize each plan specifically to your needs.
I’m Here For You
In closing, I’d encourage you to call me and have me do your insurance application for you. I don’t charge you anything for what I do, so why not take advantage of it! I promise I will teach you something new you didn’t know, and I will protect you better than you may know how to protect yourself – simply because this is the only thing I do for a living, and I love it! So trust in me, and I promise I will steer you in the right direction and put together a balanced insurance package that will give you peace of mind knowing you’re covered the right way.