Medical Benefits Broker

Friday, June 17, 2022 12:09 Posted by Admin

When it comes to searching for an affordable group health care plan, there are numerous factors to consider. One such consideration is working with a health insurance, or medical benefits broker. Whether you’re looking for individual coverage for yourself (and potentially your family as well), or you’re an employer trying to locate the best medical benefits options for your employees, using a broker can help you save both time and money in the process.

Medical benefits brokers will shed light on the entire process of buying health insurance, breaking it down so that it is nearly effortless for you to find coverage that is best suited to your unique needs. When, or if, you choose to partner with a broker obtain health insurance, this article outlines some things to expect and also some things you should keep in mind.

What is a Medical Benefits Broker?

Simply put, a medical benefits broker is a professional that can help a person or business apply for and enroll in a Qualified Health Plan (GHP) through the Marketplace, while also giving guidance and recommendations regarding plan options. They are properly licensed and regulated, generally earning payments for commissions for providing their services.

What Do Medical Benefits Brokers Do?

Also referred to as health insurance brokers, medical benefits brokers are licensed professionals that assist individuals and businesses in surviving the health insurance selection process from beginning to end. Although there are some people who choose to do all the research on their plan options themselves, others are very overwhelmed by the entire process of purchasing health insurance. For these types of people, getting professional assistance is recommended and also very advantageous.

Insurance brokers also provide assistance to businesses by helping them weed through all the available options to find the ideal healthcare plan that fits within the budget and needs of the organization.

Benefits of Using a Medical Benefits Broker

When you choose to work with a licensed and professional medical benefits broker to purchase health insurance, you enjoy the peace of mind knowing that your individual or employer-sponsored plan has the necessary coverage at the best rate. Purchasing insurance can be especially beneficial for those looking for individual health insurance.

With that said, here are some of many ways in which the services provided by a medical benefits broker are helpful:

  • Customized recommendations. Brokers will explain the advantages and drawbacks of all the different benefits packages available to you. They tailor their advice to your individual needs in order to help you choose the ideal plan.
  • Quick and convenient access to support. When working with a broker, plan holders are given a designated point of contact that can help them solve issues with care access, coverage eligibility, claims payments, and other potential problems along the way. All of these convenient support services are unique and not available on any website.
  • Specialized health insurance expertise. Brokers have exceptional knowledge surrounding the healthcare industry. They will break down and help you understand important medical care coverage terms, while also making sense of all the options available to you. Brokers are also great with helping elderly individuals understand their Medicare coverage better and their options regarding long-term medical care.

Agent vs. Broker – What’s the Difference?

Both medical benefits brokers and medical benefits agents act as the middleman between the individual looking to purchase insurance and the insurance company itself. They are also legally compelled to help people find affordable medical benefits that suits their needs. The term ‘broker’ and the term ‘agent’ are often used interchangeably in the health insurance world, however there are some key differences between the two professions.

Medical Benefits Agent

Medical benefits agents have direct contractual agreements with insurers. In most cases, they work on behalf of a single insurance company and, therefore, only sell that company’s health insurance plans. For instance, an agent working with Cigna only offers Cigna plans.  

Medical Benefits Broker

A medical benefits broker, on the other hand, acts on their own and separately from insurers. Instead, the work with a number of carriers that either pay them a percent or a flat commission rate on the plans that they sell to clients. If you choose to work with a health insurance broker, the plans that he or she pitch to you are ones that will have an impact on their success or failure.

What is a Health Insurance Agent?

Health insurance (medical benefits) agents, or representatives, are just that – representatives of one insurance company or a couple different ones. There are generally two main types: captive and independent. Captive agents work with just one insurance company, while independent agents represent multiple. With medical benefits agents, they will not charge you any fees personally.

Instead, the compensation that agents get is via either their commissions and/or salary and commission. The quotes that they offer you are in line with the ones offered by the insurance company themselves. Agents that sell products on an insurance company’s behalf have to be appointed to do so. This appointment is a contractual agreement between the insurer and the agency, listing the products that they agency is permitted to sell and the commission tied to each.

Generally speaking, the appointment also states that the agency can confirm or bind the policy. Though, not every policy can be bound through an agency.

Understanding Binders & Binding

Binding simply means that the insurance policy is confirmed, whether it be verbally or in writing. The binder itself refers to a policy that provides temporary covered to the insured individual, distributed by the insurance company. For most medical insurance plans, there is typically a waiting period that the insurance company establishes between the purchase date and the date the plan goes into effect.

This is called the ‘implementation period’ and often lasts between 30 and 60 days. Some agencies or agents are permitted to bind policies based on type. Whereas, others must be provided by the insurance company itself.

Quick Note: While this may be a no brainer, it is crucial to keep in mind that getting health insurance quotes does not mean you are covered. It is simply an estimate, not coverage.

Frequently Asked Questions

What is a broker fee in medical insurance?

Also known as an ‘admin fee’ or ‘intermediary fee,’ broker fees are charges that some brokers tack onto an insurance policy. Fees range considerably in size, typically based on the size and how complex the policy itself is.

What other ways can you buy insurance without going through a broker?

You can choose to work with a captive or independent agent. Aside from this, your other option is to do all the leg work yourself and go directly through your insurance company of choice – whether online or over the phone. Some insurance companies do not use agents, meaning you will work directly with the insurer.

Whether you’re an employer looking for the perfect medical benefits package for your employees or you’re looking for individual insurance for yourself, Taylor Benefits Insurance Agency can help! With over thirty years of experience in this industry, we have the knowledge, experience, and dedication to help you find a plan that fits both your needs and your budget.

So, if it’s a “medical benefits broker” that you need, don’t hesitate. Contact us now to get started!

Written by Todd Taylor

Todd Taylor

Todd Taylor oversees most of the marketing and client administration for the agency with help of an incredible team. Todd is a seasoned benefits insurance broker with over 35 years of industry experience. As the Founder and CEO of Taylor Benefits Insurance Agency, Inc., he provides strategic consultations and high-quality support to ensure his clients’ competitive position in the market.

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