** DISCLAIMER**: Every broker is different, as is every client, these are some tips and tricks I’ve personally found helpful.
Insurance, like so many things in life, is dependent upon personal preference and circumstance. With that being said, as working as an agent for a year and a broker for almost 4, I always let my clients know: Although I make recommendations, no one knows your needs better than yourself.
I recently chose to leave the insurance industry but thought I’d share some tips, tricks and just rules of thumb for choosing a plan from a professional and personal perspective. I hope you find this helpful in your next search for coverage!
Choosing Your Insurance – Tips From Your (Not So Local) Broker
1. Know What You Need
– Know what’s most important to you and prioritize. What/Who MUST you have coverage for? Things to consider would be:
- Your treatment plan
- Upcoming hospitalizations
2. Know Your Budget
- Nothing grinds my gears more than speaking with someone who has no input on cost. Unless you just have bags of money lying around somewhere, you should know how much you can afford to come out of your pocket. Things to consider would be:
- Would you rather pay more monthly to get a lower out of pocket for your visit?
- Is it highly likely you will have multiple hospitalizations in the year?
- Do you see a certain physician frequently? Can you afford to pay X amount of dollars every time you go?
- Can you afford to pay for your entire bill until your plan kicks in (at X amount of dollars)? – AKA deductible
3. Know Your Wants
– So we’re all guilty of this right? Saying we absolutely NEED something that we actually want for convenience or just the satisfaction of having it. Really sit down and determine what you prefer in a plan but may be able to live without. Often times you can still have these things, but they just don’t need to be placed at the top of your list. A prime example of this would be networks. When I get on the phone with certain clients the first thing they yell out before I even introduce myself is “I DON’T WANT NO HMO! I NEED A PPO!” – More often than not, when I ask this participant what they don’t like about HMOs they respond with a bunch of misconceptions and assumptions. You don’t NEED a certain network unless your NEED certain physicians and they’re not accepting of the HMO. If you have all of your physicians AND hospitals in the network of an HMO and the coverage you want at an amazing price with worldwide emergency coverage included, what is the point of paying an extra $100/m for a PPO? (Exaggerating a little but still, I’ll wait). – Don’t get me wrong… This is not to say that network is insignificant in your coverage choice. This is just simply stating that while it may be personal preference to have a certain network, it may not be a reason to completely filter out others. Things to consider when addressing wants:
- Providers that you like but do not need to see
- Providers you are considering seeing in the future
- Extra benefits like Silversneakers
- S0 deductibles
- Insurance company
Okay, you’ve considered those factors. Now what? Now it’s time to filter down your options. Maybe you’ve decided your physicians and hospitals are a must but you’re flexible on your network. Save your providers to your search. Seeing plans that don’t cover them all? Weed those out. UNLESS: If it’s a PPO plan that covers most of your physicians and you don’t mind paying the out of network cost share, keep it to the side for further consideration.
We’ve found your doctors! Now prescriptions! A lot of plan tools will show you if your prescription has any kind of restriction placed on it by the insurance company (ie: quantity limitations, prior authorization, ect ). Don’t be afraid of restrictions or cause these to turn you away from a certain plan. Restrictions are set in place to help you, and while they are not always convenient, if your physician provides proper documentation in a timely manner the insurance company should be able to get the request approved.
PLEASE NOTE: When reviewing tiers for your medications, each insurance company/ plan will determine their own tier for your medication. Just because your medication is a tier 2 on your current plan does not guarantee it’s a tier 2 under every plan. Nor does it have to remain in the same tier under your same plan for the following year. Be sure to review medications carefully when choosing coverage.
By now, you should have narrowed down your results quite a bit. By now you should only show plans in which cover all (or in your PPO case, most) of your physicians and all of your medications.
Now it’s time for benefits! If you’re just looking for the overall premium and rx cost in a year then organize your plans by yearly cost. If you’re like me, you are going to compare premium to benefit. I’d rather have a $300/m plan that covers my hospitalizations at no cost to me with a $0 deductible than a $50 plan with a $350 deductible and $900 out of pocket for each hospitalization – BUT that’s just personal preference. Think about the out of pocket you’re willing (and able) to deal with for routine visits to primary and specialists, then think about how much you would be able to pay out of your pocket in case of an emergency visit or hospitalization.
Once you find the benefits you like, look at the premium. Is the price worth the coverage?
These are just some things I go by when recommending coverage and choosing my own. I hope you found this helpful!
As always, thanks for reading. Before you go:
Who’s your favorite insurance company? Let me know in the comment section!