Licensed agents or brokers can be helpful in helping consumers through the complex process of obtaining health insurance. (Courtesy photo)

How to have a stress-free open enrollment

Consumers ought to consult agents while shopping for health care

By Janet Trautwein

Millions of Americans are hunting for health insurance. The Affordable Care Act’s open enrollment period began Nov. 1. Consumers in more than three dozen states can log onto HealthCare.gov to shop for coverage for the coming year.

The process can be intimidating. Every policy offers a different mix of premiums, deductibles, benefits and provider networks.

Fortunately, there are plenty of free resources out there that can help consumers secure coverage that fits their needs and budget. Among those resources are licensed, professional health insurance agents and brokers who have a long history of guiding consumers through the process of buying a health plan.

Open enrollment is brief. Those who don’t receive health coverage through work or the government only have until Dec. 15 to select a plan on HealthCare.gov for 2020. The 12 states and the District of Columbia that operate their own insurance exchanges have different deadlines.

Seniors covered by Medicare have until Dec. 7 to switch from the traditional version of the program to a private Medicare Advantage plan, or vice versa. They can also opt for a new Medicare Part D prescription drug plan during Medicare’s open enrollment period.

Despite that small window, it’s crucial that people get covered. Going without insurance is a huge financial gamble.

Treating a basic broken arm, for instance, can cost several thousand dollars. A ride to the hospital in an ambulance can run into the thousands of dollars, too. Injuries sustained in a catastrophe like a car accident can be many times that.

Unsurprisingly, people without insurance often struggle to afford medical care. They’re twice as likely to experience problems paying medical bills as those with coverage, according to the Kaiser Family Foundation. They’re also more likely to have to use savings or cut back on other necessities to pay for medical attention.

Health insurance can protect people from potentially debilitating medical expenses — if they choose their policies wisely. That can be tough.

One survey found that just three of every 10 Americans could correctly define “premiums,” “co-pay” and “deductible” — three of the most important terms in health insurance. Half of people say they’re only “somewhat confident” in their ability to pick a health plan that suits their needs.

They’ll have more plans to evaluate this year. About 175 insurers have decided to offer coverage across all the exchanges this year. That’s 30 percent more than in 2018.

Agents and brokers can help consumers young and old make sense of their options. They’re licensed by the state to do so — and typically must adhere to rigorous continuing education requirements to stay on top of the latest developments in the insurance industry.

About three-quarters of brokers spend “most” or “a lot” of their time explaining coverage to clients — everything from assessing eligibility for federal tax credits to determining whether a given plan covers the prescription drug a consumer needs. Those tax credits can save consumers hundreds, even thousands of dollars. The federal government subsidizes premiums for those who earn up to four times the poverty level, or more than $103,000 for a family of four.

Not everyone is aware of those credits. In 2016, officials found that 2.5 million people who likely qualified for these credits missed out by purchasing coverage outside the exchanges.

Agents and brokers also serve as consumers’ advocates before their insurance companies. One-quarter spend most or a lot of their time helping clients resolve claims questions or disputes with insurance carriers.

That kind of advocacy work is popular with consumers. More than four in 10 people who purchase insurance through the exchanges rely on the guidance of a broker each year.

Most consumers have more insurance choices during this year’s open enrollment period than they did last year. They’d be wise to consult a licensed, professional agent or broker to make sure they make the most of those choices.

Janet Trautwein is CEO of the National Association of Health Underwriters. For more information, visit www.agent-finder.org.

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