Health coverage is not a “one-size-fits-all” product. As a health insurance broker, I pride myself on having a plethora of options—including the Marketplace, medical cost-sharing plans, and employer-sponsored options.
Many agents limit their offers to either short-term medical or Marketplace plans. Today, these plans have become incredibly expensive and expose policyholders to high financial risks. To find the right plan for your unique needs, we need to gather essential information before we meet.
Here are four critical factors I consider before making plan recommendations to my clients.
- Chronic Conditions and Anticipated Medical Needs
Sharing your anticipated medical needs guides us toward plans that keep your out-of-pocket costs low. You usually know right away if you have an upcoming surgery, require regular treatments, or are pregnant.
However, people easily forget about underlying, managed chronic conditions. For example, a cancer diagnosis in remission, something an individual would consider a non-issue, can completely knock out certain coverage options. Our initial conversation aims to bring these conditions to light. They will not necessarily disqualify you from coverage, but knowing about them ahead of time can save you thousands of dollars in medical bills.
- Prescription Medications
Reviewing your prescription medications reveals underlying conditions and directly can shape your plan selection. Insurance companies are excluding brand-name and specialty drugs from coverage more than ever before. We use plan drug formularies to verify exactly which drugs your plan covers.
As a health insurance agent, I help you find the best tools to keep your prescription costs down. At Gordon Health Group, we equip our clients with unique strategies to save money. In some circumstances, you will actually save more money by not using your health insurance for your prescriptions and instead turn to some of the great cost saving tools we recommend.
- Provider Networks: How Important Are Your Doctors?
For many people, a trusted relationship with a doctor is priceless. Insurance plans only cover providers who contract within their specific network, and many plans offer zero out-of-network coverage. You must know in advance which doctors your new plan covers, and which doctors you will lose access to.
If you are leaving a large corporate group health plan, you might be used to large PPO networks and seeing specialists without a primary care referral. Very few individual health coverage options offer this luxury. While we always check the provider network for your key doctors before you enroll, you should also call the provider’s office directly to confirm they accept the recommended plan.
- The True Financial Impact
The financial cost of your coverage matters most. When evaluating price, we will not just look at the monthly premium, but also include the deductible (what you pay before insurance kicks in) and the out-of-pocket maximum (the absolute most you will pay in a single year).
Even on a tight budget, we can introduce you to options that offer lower monthly fees and excellent protection against major medical situations. If you rarely use your health coverage, a “non-traditional” plan can keep your hard-earned dollars in your pocket.
Find the Right Partner
Choosing health coverage can feel complicated and overwhelming. Turn to a true health insurance broker who knows the industry inside and out. Partnering with Cindy Gordon will lead you straight to the best plan for your specific requirements, giving you the peace of mind to enjoy life knowing you are fully covered.