Agents Can Help You Pick Healthcare Plan
The Savvy Consumer

By Teresa McUsic

A deadline of March 31 is coming up for choosing your individual health insurance plan during open enrollment, and while access to the federal government’s website,, has improved, consumers are getting bogged down with another problem—picking a plan.

“Plan designs are varied and complicated,” said Stacey Pogue, senior policy analyst with the Center for Public Policy Priorities in Austin. “Every single plan is different.”

For a professional source of help in sifting through the plans, consider asking an insurance agent who specializes in healthcare plans. Agents receive a commission for each plan sold, but the carrier pays it, not the consumer.

“Consumers are, in a way, leaving money on the table if they don’t seek the assistance of insurance professionals in shopping for coverage that best meets their needs and preferences, ” said Mark Bellman, president of the Texas Association of Health Underwriters.

Pogue says that health insurance agents will play an important role in the roll-out of the healthcare reform law.

“They are a great resource to go to for picking a plan because they understand the ins and outs of all these plans,” she said. “We need the agents on board.”

Benefit advisers’ experience and insight are not the only reasons to seek their help. Bellman said.

“Health agents are required to meet strict state-level exam-based licensing laws and annual continuing education requirements, as well as significant federal and state privacy, security and market conduct requirements,” he said. “Our membership has gone up this year because agents are looking for education on the healthcare law.”

To find a local health insurance agent, consumers can use the directory at The directory lists 1,800 members, including 600 in DFW, Bellman said.

On the healthcare website, consumers in Tarrant County have 36 plans to choose from, including 11 bronze plans, 13 silver plans, 10 gold plans and two catastrophic plans. Insurers include Blue Cross/Blue Shield of Texas, Aetna and Cigna Health.

But Bellman said there are many more individual plans and carriers outside of the exchange.

“The only reason to go to the exchange is if you qualify for the subsidy,” he said. “An agent can help you find more plan options outside of the exchange.”

Agents also will conduct a cost/benefit analysis of the plan’s coverage and cost and how it fits with your individual needs, Bellman said.

“If you specialize in health insurance, you know where the sweet spot is for rates and plan designs,” he said. “No plan fits all people.”

Bellman said the No. 1 issue for consumers picking a new plan is getting their previous doctors and hospital. He warned that your doctor and hospital may not be in a new plan even if you choose your previous carrier.

“For carrier to compete on the exchange they have had to narrow their network offerings,” he said. “I’ve seen the same carrier on the exchange offer one-third of the doctors than they previously had in network and one-half of the hospitals,” he said.

While smaller networks may be one thing to watch out for, consumers also will enjoy richer benefits than most had on previous individual policies. Pogue said there are 61 preventative health benefits required by law to be covered before the deductible, co-pays or coinsurance are paid.

These benefits cover a wide variety of preventive services, with 15 benefits for all adults, 21 benefits specific to women and 25 specific to children.

Among the no-cost coverage in the new plan are immunization for all major diseases and tests including colorectal screenings for those 50 and older, mammograms for women older than 40 and osteoporosis screening for women older than 60.

Also included at no cost in all new plans are annual screenings for such conditions as diabetes, HIV, cholesterol and depression. Other services covered include diet counseling, cessation intervention for smokers and contraception for those covered by a plan not affiliated with a religious group.

For a complete list of what is covered, go to

Bellman said a health insurance agent would be able to do a financial assessment on whether it is best to keep your old plan or move to one with more benefits.

Jackie Spragins, an individual health agent with Fort Worth
based Higginbotham, said most of her clients are sticking with their old plans for this coming year.

“The new plans are too expensive unless you have a subsidy,” she said. “But I have done a lot of spreadsheets comparing the old and new plans for my clients.”

Full maternity coverage, a requirement of the new plans, is something to consider if you are planning a baby in 2014. Also, catastrophic coverage and guaranteed issue are elements of the new plans, Spragins said.

“I have one client who needs a kidney transplant and switched to a new plan,” she said. “His name came up on the list for a new kidney in January, so for the price of one premium he will get a $300,000 claim”

Spragins recommended patience when switching plans and acting as soon as you get the information from your agent.

“I have some people just now making their decisions and they’ve had the information since October,” she said.

Teresa McUsic’s column appears Saturdays in the Fort Worth Star-Telegram.

By the Numbers    

Health Exchange Insurance Roll Out through Nov. 30, 2013
    Texas    U.S.
Completed applications 118,577 1,827,440
People covered through applications 244,695 3,692,559
Getting financial assistance  62,321


Remaining uninsured             6.4 million 47 million
Source: Department of Health and Human Services, Kaiser Family Foundation, Center for Public Policy Priorities

Picking a Healthcare Plan
1. Find out if your doctor and hospital preferences are included in the plan’s network. Many of the new plans have smaller health professional networks for patients to use.
2. Determine what you will have to pay out-of-pocket on expenses like deductibles, co-pays and possibly co-insurance.
3. Make sure the plan covers medical services or benefits that you require, as well as future health care needs you may have.
4. Make sure the plan covers any prescriptions you take.
5. Ask about processing time and what will happen after you apply so you will know what to expect.
6. To find a local health insurance agent, go to

Source: Texas Association of Health Underwriters

You can reach Teresa McUsic at