Tailoring Health Insurance Plans to Client Needs
Your client’s health needs are as individual as they are. The many health plans, varied features, and wide range of costs can easily throw clients into analysis paralysis, making it difficult for them to choose the best plan. When you can tailor clients’ health plans according to their wants, needs, and expectations, you’ll have a customer for life.
Customized health plans improve health, reduce costs, and enable greater access to healthcare. As a healthcare insurance agent or broker, you have the privilege of helping clients understand how the current trends in healthcare impact them on a personal level.
We’ll explain how to present the current landscape of health insurance and review your role as an agent. We’ll also explain how to understand your clients’ needs, give a brief overview of plans, and provide tips on how to customize your presentations.
Shortcuts:
Understanding the Current Landscape of Health Insurance.
The Role of Insurance Providers and Brokers.
Understanding Client Needs: Conduct a Comprehensive Needs Analysis.
Types of Health Insurance Plans.
Overcoming Challenges in Tailoring Health Plans to Client Needs.
Personalized Health Insurance Plans Improve Quality of Life.
Understanding the Current Landscape of Health Insurance
Too many health insurance choices confuse clients. It’s easy to see why. They must choose from a range of coverage options, from catastrophic to comprehensive, and everything in between.
Clients also have to consider how much they can afford to pay for healthcare coverage. The rising costs of healthcare cause even more frustration for your clients.
Unfamiliar healthcare terms make the task of shopping for a health plan even more challenging.
Most people find that choosing the best plan for their unique needs is nearly impossible to navigate without professional help.
Selling health insurance is equally complex for agents and brokers. Regulations and compliance matters change every year. Selling is difficult even for agents and brokers who’ve been in the industry for many years.
Nonetheless, agents and brokers provide a valuable service to clients in helping them get the best healthcare plan for themselves and their family members.
The Role of Insurance Providers and Brokers
Your role is to make such a difficult task more manageable. Most clients will welcome your help and advice. In your role, you assess your clients’ needs by getting to know them and their common healthcare issues.
Once you’ve reached a consensus with your client about their needs, you can create a customized plan to meet those needs.
Health Insurance Broker/Agent Expertise Enhanced by Technology
The insurance industry has long lagged in digital transformation, although it has started to catch up in recent years. New technologies, particularly artificial intelligence (AI), have become a transformative force across industries.
A one-size-fits-all approach to health insurance plan sales won’t likely be as effective as an individual approach. Customization is key to ensuring your clients get the best plan at an affordable rate.
Technology enables you to get up to speed quickly on identifying a client’s needs, setting the stage for guiding them toward the best health plans. Technology also benefits clients as it enables transparency in pricing and coverage details.
The right software enables clients to get quotes online at their convenience, yet your role doesn’t stop there. Clients may not understand what the coverages mean or how they apply in a practical sense.
You can build value by having discussions with clients about past, current, and medical concerns, including how much they would have to pay for various treatments, medications, and therapies.
The right coverage may allow your clients to get better access to the treatments, medications, and specialists they need to truly enjoy quality of life.
For example, a client who has a history of heart disease needs access to cardiac specialists and hospitals they trust. They may also value access to certain medications, smoking cessation, or nutrition and fitness programs.
Another consideration, especially for people living with chronic health conditions, is helping them select an affordable plan with reasonable deductibles and out-of-pocket costs.
An appropriate plan may prevent someone from facing medical bankruptcy.
KFF cites the following statistics reflecting concerns about medical bankruptcy:
- Approximately 14 million people in the U.S. owe more than $1,000 in medical debts
- Approximately 3 million people in the U.S. owe more than 410,000 in medical debts
- Overall medical debt for Americans is upwards of $220 million
Health insurance technology gives you access to analytics that address demographic and income levels. Young adults typically have fewer healthcare needs than older individuals, although they may need reproductive services.
Older individuals may have received various diagnoses or are taking regular medications.
People with lower incomes may be particularly price-conscious. You can assist them by finding good coverage at the lowest prices, higher cost-sharing plans, or subsidized coverage.
Parents with children may be more interested in pediatric coverage, vaccinations, routine checkups, dental care, and vision care.
Senior clients may be interested in long-term care coverage or other geriatric services.
As you consider each client and their needs, you can guide them toward health plans that offer the coverages they value most and alleviate coverages they’ll likely never use. Clients will surely see the value in that.
Overall, analytics give you the data you need to make recommendations for clients based on the needs of specific family structures.
Take the family’s needs into account and tailor a customized health insurance plan accordingly to win the sale.
Understanding Client Needs: Conduct a Comprehensive Needs Analysis
The first step in understanding your client’s needs is to conduct a comprehensive needs analysis. As part of your analysis, inquire about each family member’s existing health insurance, current life stages, medical histories, health conditions, lifestyle factors, and budget needs.
You’ll need to ask about each family member’s current health plans, and whether they’ll change their plans during an open enrollment period or a special enrollment period.
Be sure to cover the following types of health plans:
- Group health insurance
- Marketplace plan
- Private plan (MEWA, church plans, student health plans, etc.)
- Original Medicare
- Medicare Advantage
- Medigap
- Medicare Part D
- Medicaid
You’ll also need to consider the family’s demographics. Is it a single individual, an aging married couple, or a family with eight children? Will any of the children be going away to college over the next year? Will any individuals be going off their employer-sponsored plans and signing up for Medicare?
Abide by HIPAA Compliance Regulations
Brokers and agents must be aware of HIPAA compliance regulations for insurance brokers. It’s okay to ask about their general health conditions, but you don’t need to be invasive. Allow clients to share whatever information they’re comfortable with.
Be sure to check your Business Associate Agreement for each company that you sell for and clearly understand their security rules, privacy rules, and breach notification requirements.
Types of Health Insurance Plans
Your client’s existing health plan may serve them well for the time being, yet future life changes may require changes in their health plan.
Before starting your presentation, it’s a good idea to take stock of their current plan and ask whether it will meet their needs over the coming year.
By asking the following questions, you will get a clearer picture of potential changes in health plan needs:
- Which family members do you need your health plan to cover?
- Do you have access to a group health plan?
- Will you be changing jobs that will cause you to lose or gain a group plan?
- How soon will you or another family member be eligible for Medicare?
- Will you need a short-term health plan?
- Do you or other family members have preferred doctors or hospitals?
- Do any family members need maternity care?
- Do you or other family members have any pre-existing or chronic health conditions?
- Will you consider a high-deductible plan?
- What things do you like about your current health plan?
- What things have you disliked about your current health plan?
- What type of premium fits into your budget?
- Is there an out-of-pocket maximum or maximum deductible you prefer?
Also, be prepared with answers to common health insurance questions.
In learning more about your clients’ needs, it helps to give them a brief overview of health plans:
- Exclusive Provider Organization (EPO)
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- Point of Service (POS)
- High-Deductible Health Plans (HDHP) with Health Savings Account (HSA)
- Short-term health plans
Employer-sponsored plans are usually the most advantageous. They may also include other benefits such as life insurance or plans that cover critical illness, vision, dental, disability, or other benefits.
An EPO is a managed care plan that requires them to use specific doctors, specialists, and hospitals except in an emergency.
An HMO limits coverage to medical providers in the HMO’s network. This type of plan only covers out-of-network providers in an emergency.
With a POS, clients will pay less for using preferred network providers. Also, they must get a referral from their primary care doctor before scheduling an appointment with a specialist.
PPO members will pay less if they use network providers, and they can use out-of-network providers at an additional cost.
Customization Strategies for Clients
Once you’ve identified a suitable health plan for your clients, it’s time to help them customize their coverages.
Let’s take the example of an individual who lives with a chronic condition such as heart disease, asthma, or diabetes. This individual may require frequent doctor visits and continuous monitoring. Prescriptions may be expensive.
A person with a chronic condition will likely be looking for comprehensive coverage for prescription medications. They may also seek health plans with low copayments and deductibles for doctors and specialists. Telemedicine services may also be an attractive feature for this client.
Here are some other strategies to enhance the recommendation further:
- Adjust the deductibles
- Adjust the out-of-pocket maximums
- Add supplemental dental, vision, critical illness, life, or disability insurance
- Select a plan that includes wellness or preventative care benefits
As you guide clients toward the best health coverage, be cognizant of their objections and challenges in moving forward with your recommendations.
Overcoming Challenges in Tailoring Health Plans to Client Needs
Today’s clients are busy people who value the ease of doing business. Health insurance phone appointments save you travel time and expense.
When you can help clients identify their health plan needs, recommend the best plan, and streamline the administrative process, it makes their decision-making easier
Clients need the necessary knowledge and tools to help them make informed choices. With CrankWheel’s screen-sharing tool, you can clarify their needs and describe how the right health plan meets them.
Once clients have chosen a plan, they may be discouraged by the difficulty of getting registered on a health plan and navigating the provider’s website. Once again, CrankWheel’s screen-sharing tool allows you to walk them through the registration steps and learning where to find information on the provider’s site. These steps will ease their emotional burden and strengthen their trust in your expertise.
Lastly, some clients may be concerned about giving you their private health information, especially if they are new clients. As part of your presentation, you can add a slide that clearly explains the privacy and data security laws pertaining to health plans and your strategy for protecting their personal data.
Personalized Health Insurance Plans Improve Quality of Life
Medical advances in recent years have helped many people improve their quality of life. From early intervention to new medicines and wellness programs, health plan providers are responding to the need for customized solutions and meaningful health plans.
The near future may continue to bring even more opportunities to serve client needs by offering the best in individual health plan customization.
Your role as a health insurance agent helps to unravel the many choices consumers must make in analyzing their health plans and deciding to keep what they have or opt for something better.
Learn how instant screen-sharing with Crankwheel can help you tailor health insurance plans to client needs and achieve more sales and try it for free.