Although Affordable Care Act (ACA) plans offer coverage for 10 essential health benefits, these plans don’t protect against every health concern. Your clients may greatly benefit from supplemental insurance, particularly dental, vision, and hearing plans.
Below, we’ll give you five tips on how to find the right ancillary coverage for your clients who would like to maximize their protection and shield themselves from higher out-of-pocket costs.
Why Pair Supplemental Insurance with an ACA Plan?
Supplemental insurance plans often allow people of any age to better manage their health care costs. Primary forms of health insurance, including ACA plans, don’t cover everything your clients might think. Most notably, dental, vision, and hearing benefits are not typically included in ACA plans for adults.
All ACA-compliant health plans fit into one of four metal categories and have a set actuarial value. The actuarial value is the percentage of average costs that the plan will cover. Bronze plans have a 60/40 percent actuarial value, meaning the policy holder is responsible for 40 percent of their health insurance costs. Bronze plans can be an affordable option for many families and individuals but can include a higher deductible and hospitalization costs. Pairing an individual health plan purchased through the marketplace with a supplemental plan, like a hospital indemnity policy, is a great way to help your clients limit their out-of-pocket potential expenses. Adding on a supplemental policy can give clients flexibility and may even be a more affordable, customized option than purchasing an individual health plan in another metal category or at a higher actuarial value.
With the proper coverage and planning, ACA clients can avoid paying for services out of pocket and experience more positive health outcomes.
With the proper coverage and planning, ACA clients can avoid paying for services — like routine dental cleanings, glasses, and hearing exams — out of pocket, or greatly lower their costs, and experience more positive health outcomes. There are additional premiums for these insurance plans, but the cost is much more manageable than paying for health services without coverage.
When individuals have adequate health care coverage, it also reduces the strain on the health care system, particularly in the case of emergencies or accidents. Health care spending accounts for 18.3 percent of gross domestic product. Additionally, out-of-pocket health care spending accounts for 10 percent of the national health care spending, according to Centers for Medicare and Medicaid Services. Programs such as affordable health care and private insurance help to manage these numbers.
Tips for Helping Under-65 Clients Find Supplemental Insurance
Here’s our advice for finding the right coverage to supplement your clients’ marketplace plan.
1. Review Your Clients’ Current Coverage
Evaluate your clients’ current marketplace plan. Do they have needs that aren’t being met? It’s important to consider what coverage is included in your clients’ marketplace plans. Some plans may include dental, vision, or hearing benefits for adults. In this case, it may be more affordable to select a stand-alone plan for the specific coverage your client will utilize more often.
Perhaps your client wears glasses and makes frequent visits to the eye doctor every year. A dental, vision, and hearing or stand-alone vision plan would be great for this client. A conversation about supplemental coverage could begin with talking about their current glasses and vision needs.
Another flexible option to consider pairing with an individual health plan is accident insurance. With the maximum allowable out-of-pocket limit for ACA compliant plans increasing from $8,700 in 2022 to $9,100 in 2023, it is becoming increasingly more difficult for individuals and families to depend on their primary health plan to cover all of their needs. Accident insurance provides specific cash benefits for injuries caused by a covered accident, and these benefits are paid directly to the beneficiary and can be used for resulting expenses, such as costs not covered under the primary health plan. This type of policy can be a good fit for individuals and families with an active lifestyle or families with small children, and typically, does not require a client to pass health underwriting.
2. Evaluate Your Clients’ Health
Supplemental insurance plans may require clients to be evaluated for pre-existing conditions. Consider if their health status affects their ability to be approved for an additional plan. If your clients have pre-existing conditions, such as cancer, diabetes, and smoking or other health conditions that may cause them to be denied from coverage, make sure you educate them on this risk before applying.
3. Cover the Whole Family
Family plans are also available for supplemental coverage options. Dental and vision benefits are included in ACA plans for children under 18 but are not typically included in plans for adults. If one of your clients has a child that has hearing concerns and uses hearing aids or cochlear implants, a supplemental hearing plan may be of benefit to them. When evaluating concerns, make sure to consider the needs of the whole family, including that of the children.
4. Budget for Added Health Costs
Budget concerns are also relevant when it comes to supplemental coverage options. Most clients will be able to find an affordable plan that covers all three main concerns: dental, vision, and hearing. Clients who are new to the marketplace, but previously had insurance offered by an employer that may have covered dental, vision, and hearing services, may be surprised by the additional costs to achieve the amount of coverage they desire. When evaluating clients’ budgets, make sure they are prepared for additional deductibles and premiums. Supplemental plans have a deductible and allowances for exams and other services to reduce out-of-pocket spending.
Most clients will be able to find an affordable plan that covers all three main concerns: dental, vision, and hearing.
When working with a family, make sure you consider how many family members need coverage when accounting for costs. Deductibles differ for individual versus family coverage, depending on which plan is chosen.
5. Inform Clients of Their Options Ahead of the OEP
Before the Open Enrollment Period (OEP), evaluate all options with your clients. Consider the variables and values that are relevant to the type of plan your client has (if they’re renewing) or is likely choosing (if they’re switching plans or enrolling for the first time). There are multiple carriers that have dental, vision, and hearing and accident insurance plans available. Look over all options and inform your clients of the best choice for them.
There are dental plans available through the exchange, but these plans can only be sold at the same time as a health plan with a qualifying enrollment period such as the annual OEP. Being aware of your clients’ options before the OEP is an excellent way to be prepared for the unexpected.
One added benefit of selling dental, vision, and hearing plans is that they can be sold year-round! This is a great opportunity to generate new business outside of OEP.
Ritter Is Here to Support You
Navigating these scenarios and considerations can be difficult. That’s why we’ve assembled a team of trusted sales specialists at Ritter Insurance Marketing who specialize in and have expert knowledge on marketplace and under-65 health plans and ancillary coverage. Our sales specialists are available to help you answer the tough questions and solve issues that may come up along the way, as well as to review your portfolio and make recommendations.
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Supplemental plans are an excellent way to protect your ACA clients from high out-of-pocket costs and put routine health care services, like dental, vision, and hearing care, within reach. We hope these tips not only help you select the right plans to meet your clients’ needs, but also generate new business opportunities and additional income year-round!
Ritter is prepared with staff and resources to help you achieve your business goals! If you’re not a Ritter agent yet, consider registering today! With your Ritter agent status, you’ll have access to a diverse library of tools such as our CRM tool, a full library of eBooks and Guides, and an expansive library of contracts to make selling marketplace and supplemental coverage even easier.