3 ways advisers can successfully navigate health plan networks
As we enter the New Year, there is one wish that most everyone can agree upon: access to the healthcare provider they want and the services they need.
But moving into 2018 and beyond, successfully delivering that accessibility for small-group employers and their workers requires more network navigation know-how from brokers than ever before.
For agents, the days of identifying, offering and then helping clients select from a handful of broad-based network and plan options are very much in the rearview mirror.
Instead, today’s advisers must serve as network navigators, expertly steering customers to an ever-widening range of plan choices increasingly offered in narrower or more limited networks. These options are attractive as they help hold down premiums, but they do require brokers to now be fully versed in the myriad of available choices to assure clients that desired providers are considered in-network by a selected plan.
Also see: “How small-group advisers can stay the course in a sea of uncertainty.”
When it comes to network navigation, here are three things for brokers to keep in mind for the New Year:
1. Know the nitty-gritty network options. It wasn’t that long ago that more networks than not included all referred physicians, specialists and other providers for employee access. To adjust to recent healthcare reform, carriers had to rebalance options to align with metal plan tiers and other mandates. Meeting these requirements has meant cutting back on costs and in many instances, has led to reduced or limited access to care through contracted plans.
As a result, brokers are now faced with the challenge — and the big opportunity — of ensuring that medical groups, hospitals, doctors, pharmacists and more are in a particular network. Smart agents who intimately understand the variety of available networks and carriers and what each potentially offers are poised for success. For example, a particular hospital might have traditionally only been available in one plan and with one carrier, but now it might be available in a smaller network through a different carrier.
2. Narrow networks can be nifty. Narrow or limited network plans are growing in popularity, according to reports from Kaiser Family Health Foundation and others. These studies have found that in the past few years there has been more of a willingness from employers to base contributions on plans with limited or regional carrier networks.
With the guidance of a knowledgeable broker, most members in a group will often be able to find their preferred physicians within these networks. Additionally, while plans may be narrower, many actually provide richer benefits (often at lower overall costs) — that makes them more attractive to employees.
3. Customer-centric choice and demand. The fact is that the one-size-covers-all plan and network are giving way to more focused options. Brokers can help turn this into an advantage for clients, especially given the rising demand for customized choice in healthcare and many other facets of daily life.
Think of it this way. Cable television plans can cost hundreds of dollars monthly while subscription services like Netflix are less than 10 bucks per month. Quantity does not necessarily trump a “skinnier” option if the subscriber gets the programming they want and value.
The same holds true for individuals and the growing number of multi-carrier and network options to choose from. The right plan is the one that caters to their specific needs — it’s the broker who will need to help shine the light on the best option.
So, dive into networks and know them inside and outside for clients in the coming year and beyond. Doing so will help ensure a successful 2018.