Working with a knowledgeable health insurance agent helps navigating the system much easier.
By Lindsay Field Penticuff
Navigating health insurance can be difficult, frustrating, and costly. Period. But it doesn’t necessarily have to be, especially if you work with a professional health insurance agent who can help you negotiate and figure out the best healthcare plans for you and your family.
“People don’t need to be frustrated, though. They just need to find someone who cares about them,” says Susan Smith-Hopkins, owner of Your Best Choice Insurance Services in Marietta. “My main goal for my clients is to make sure that no one loses their financial stability due to a medical injury or illness.”
Benefits of working with an agent
Smith-Hopkins, who has been an agent since 2016, knows firsthand what it’s like to struggle with figuring out health insurance as a client. Her husband got very ill in 2009 and she became his caregiver for about six years until he passed away. “We experienced real financial blows because of the healthcare industry,” she shares. “He was on about three different group plans and, in the end, he was actually on Medicare disability. But we still almost lost everything due to medical bills.”
Throughout the process, Smith-Hopkins kept saying to herself, “There has to be something better than this.” So, about a year after her husband passed, she lost her corporate job and decided to go back into the insurance business — she had previously worked in Medicare supplements and annuities in life insurance between 1999 and 2003.
The benefit of working with an agent like Smith-Hopkins is having someone who can help guide your family through different service lines for group plans or individual coverage. “People often don’t understand that even if something says, ‘major medical,’ it’s not necessarily going to be a good plan when it comes down to the nitty-gritty,” she says. “I have read specimen policies until I’m blue in the face, but that’s what I do. Before I offer something to [a client], I will read the specimen policies that the company puts out there for the agents to review.”
She adds that the healthcare industry is very fluid, but there are many gray areas. Her goal is to educate clients and be as transparent as possible. And Smith-Hopkins works with a variety of clients, from people who left a corporate job or are recently retired to those who are divorced, widows, or widowers. She also works with several carriers and is dedicated to customizing packages to meet any client’s needs. “The healthcare industry is not a one-size-fits-all by any means,” adds Smith-Hopkins.
Upon bringing on a new client, she’ll work backward, she explains. First, she’ll ask who their current doctors are, then she’ll find out if any of those doctors are providers a client absolutely must keep. “The challenge these days is that there are so many networks and not every doctor wants to be a part of every network because it’s just more paperwork,” she says. “That is the biggest challenge; having people set up on plans that I know their providers will take, because that changes all the time.”
She also says people will look at plans because a co-pay is so low, but they should not be worried about how much it costs to go to the doctor. “What they should worry about is how much it’ll cost if they are diagnosed with cancer. That’s what people don’t think about,” Smith-Hopkins says. “I’m always saying, ‘Let’s get the best coverage for what if the worst occurs.’ People these days need to realize that you never know what’s around the corner.”
Tackling Medicare benefits at 65
Bob Smith, an independent health and life insurance agent, representing multiple major health insurance carriers, has experienced many of the same challenges as Smith-Hopkins — no relation. His office is headquartered in Tucker, is a member of the East Cobb Business Association with Smith-Hopkins, and serves clients in Cobb County and throughout Georgia and South Carolina. He’s been working in the health insurance industry since 2009.
Smith’s specialty is guiding clients 65 and older through the Medicare process and it is estimated that 10,000 people age into Medicare nationally every day. “I think the number-one issue for folks looking into Medicare options is confusion … and what’s added to the confusion is technology,” Smith says. “There are companies out there that know when people are approaching 65, and people are getting inundated with solicitations by mail, phone and TV commercials.”
Medicare is comprised of three components: original Medicare, Parts A and B; Advantage plans, which are private plans operated by insurance companies with contracts with Medicare; and Medigap. “Where it’s changed significantly over the years, especially with Medicare Advantage plans, is that more benefits have been added to the mix,” says Smith.
Because of the confusion multiple Medicare plan benefit options can cause at the time of signing up, Smith recommends working with an agent like himself and starting the process about six months before turning 65. “When somebody is turning 65, they can choose their Medicare plan three months prior to their birthday month with the chosen plan effective the 1st day of that month. Being proactive and aware of an individual’s options six months prior is better, especially now with the way Social Security is,” Smith says. “It’s always better to give more time than less when trying to apply for Medicare.”
The job of any agent to help guide someone through this process is to know a client’s needs, such as what doctors they use, what medications they take, and what potential medical issues may be on the horizon. It’s also important for Smith to work with a client and determine a person’s sense of risk. “A lot of people have a misconception that Medicare covers everything, and the fact is, it does not,” he says.
Using a cancer diagnosis as an example: A cancer drug like chemotherapy would be covered under Medicare Part B, which means Medicare will pay only 80 percent of the cost, leaving the remaining balance for the beneficiary to pay. “To protect clients, I share with them cancer plans that will either provide a lump sum or a cancer plan itself that will cover the range of what can happen with a cancer diagnosis over the life of the cancer, even including transportation and lodging if they need to go to one of the national cancer centers like MD Anderson in Houston, Texas” says Smith.
Having real-world conversations with clients about their family health history is incredibly helpful. Smith also discusses long-term care and in-home care options with clients, because with Medicare, long-term care is not covered and it’s gotten expensive. “I try to show folks that there are different options,” he says. “Not everyone goes into a nursing facility, so to control the costs, you can get plans that will pay for in-home services. It’s another arrow in the quiver to help protect folks from out-of-pocket expenses.”
And that continues to be a part of Bob’s professional goals — showing clients what’s available to help protect them from out-of-pocket expenses. “I like to use two words to frame the conversation: price versus cost,” he says. “Everybody may think they know the price of everything, but maybe not the real cost.” The price is the premium, but the real cost is, God forbid, if something happens and you’re not covered sufficiently.”
He also reminds clients not to necessarily focus on the lowest price, but rather coverage that will protect them from future potential costs. “You’re dealing with people’s lives, and it’s important to develop a trusting relationship with clients — someone who they can feel comfortable about picking up the phone and asking questions, and knowing they are going to get a call back,” concludes Smith
About Bob Smith
Health and Life Insurance Advisor
“Bob’s knowledge enables him to break down the complex decisions about Medicare coverage choices into more manageable pieces, and to present options tailored to individual need without pushing an agenda. I am most appreciative of his work with me, which provided me with critical coverage a few months later when I found myself facing an ER visit and overnight hospital stay with a large array of needed testing. I most highly recommend him to anyone looking for help with health insurance questions.”
About Susan Smith-Hopkins, Health Insurance Specialist
Your Best Choice Insurance Services
yourbestchoicehealth.com or bestchoicehealth.net
“Susan personifies professionalism. She evaluates your specific needs and presents the options with clarity and the strengths of each policy based on your specific requirements and needs. She shows great kindness, empathy and obvious caring for those she is working with which shines through. I highly recommend using Susan. You will be glad you did.”