When working with a client who is shopping for an Affordable Care Act (ACA) insurance plan from the federal marketplace or their state marketplace, there are a series of questions you should ask to better serve them.
Ask these questions in your meeting to understand your client’s needs and what they might be looking for in their health insurance plan.
How often do you typically need healthcare each year?
Asking how often your client visits the doctor each year can help you determine if they’d be better suited for a plan in a higher metal tier to have more costs covered, as long as they’re comfortable with a higher premium.
Maybe your client only visits the doctor once a year for their annual physical, or maybe they have conditions they manage with more frequent visits to providers. They may feel as though the lower deductible and lower copays are worth the higher premium.
Compare metal tier levels and estimate premium costs with our ACA Metal Tiers Handout
What is your estimated annual household income?
Subsidies through premium tax credits and cost sharing reductions help to make marketplace coverage more affordable by significantly reducing out-of-pocket costs. Your client’s annual household income is used to determine eligibility for these subsidies. Use this calculator from HealthCare.gov to estimate their subsidies before deciding on a plan.
Remind your client that, if they qualify for cost-sharing reductions, they must select a silver plan to apply those savings. Premium Tax Credits are available on any metal level.
Remind your client that, if they qualify for cost-sharing reductions, they must select a silver plan to apply those savings.
This is also a great time to remind your clients to reconcile their premium tax credits.
How much are you comfortable spending each month for health insurance?
Some clients may feel influenced by budget concerns. Subsidies can drastically reduce the amount of monthly premiums they’ll pay; however, if they’re not eligible for subsidies, clients may feel more comfortable choosing a lower metal tier of coverage to reduce their monthly spending.
Catastrophic plans can be an option for clients who are looking for enough coverage to act as a safety net but don’t use health services often and aren’t willing to spend more than what’s necessary for health insurance. These plans are only ideal for clients who want protection from worst-case scenarios, such as getting very sick or injured.
Are your doctors in a particular network that you’d like to remain in?
When evaluating your client’s current health status and medications, consider if there are doctors or specialists they’d like to continue to see. This can help you decide on a plan with a particular network if your client feels that’s valuable to them.
HMO & EPO plans limit coverage to a local network of physicians and facilities and typically will not cover out-of-network care, except for emergency medical services. These plans can be more affordable options for clients with chronic conditions.
HMO plans require a referral from a primary care physician to see a specialist, while EPOs do not. Because of this, some individuals may choose an EPO or PPO plan for added flexibility. However, these more flexible plans are also more expensive. Consider in-network flexibility, coverage, and affordability when your client is choosing a plan.
Do you take any prescription medications?
Those with chronic conditions or those who take prescription drugs may want to decide between an HMO or EPO plan that has better coverage for their condition. Typically, these plans have more coverage for prescriptions than PPO plans.
Do you have other family members that need coverage?
One of the benefits of offering ACA plans to clients in your portfolio is you can offer marketplace coverage to younger children or spouses who qualify. If they reside in the same household or are tax dependent, they could be on a family marketplace plan.
Alternatively, your clients can be valuable resources for referrals for older family members or friends who could qualify for Medicare. Selling a variety of insurance products diversifies your income and your client base!
Have you had a significant life event recently?
If your client recently got married, had a child, lost other health coverage, or has moved, they’re eligible for a Special Enrollment Period (SEP). Your client will have 60 days to select new coverage through the marketplace with this SEP. If they have not experienced any of these events, they will have to wait until the ACA Open Enrollment Period (OEP) to enroll in a plan.
Is dental coverage important to you?
Dental services for adults are not covered as part of marketplace plans. We recommend asking if your client is interested in receiving dental coverage. A supplemental dental, vision, and hearing plan or stand-alone dental insurance plan may be a great choice for these clients.
Do you have life insurance?
Think about the other products in your insurance portfolio. Are there any products your client could benefit from, such as life insurance? Life insurance can provide peace of mind and protection in case of an accident. Consider this your opportunity to offer your other services to your marketplace clients.
Don’t offer supplemental products in your portfolio? Contact your sales specialist to discuss opportunities for adding new products and growing your sales!
Asking your client these important questions will help you be a better agent and make even more sales. Use this list in your next client meeting to better understand your client’s needs.
You don’t have to have the answers to the tough questions all on your own. With Ritter, you have access to sales support, on-demand training, and resources to help you succeed with one free registration!
Not affiliated with or endorsed by Medicare or any government agency.
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