Top challenges facing health insurance professionals

Written by: Gabrielle Smith
Published on July 23, 2021.

Health insurance in America is constantly changing; where it’s being sold, how much it costs, who’s participating in it, and so much more. As health insurance professionals look to the future of the healthcare industry, staying ahead of the oncoming challenges and changes is what will keep you afloat.

We’ve identified five of the most common challenges today’s brokers, agents, and claims specialists face today, as well as outlined how you can overcome these challenges to better serve your clients as they navigate the ever-evolving healthcare space.

1. Healthcare reform

The first challenge today’s health insurance professionals face is keeping up with the seemingly endless list of healthcare reforms and policy changes. As the world sees advancements in technology, dips in the economy, and even global pandemics, policies surrounding healthcare have to keep adapting.

From the rise of telehealth to unique guidelines for those impacted by COVID-19, health insurance professionals have to continually stay informed about relevant industry news, regulations, and insights as they happen.

How to overcome this challenge…

Since there’s no stopping the oncoming flood of healthcare reform, health insurance professionals simply need to keep a close eye on the news and follow trustworthy industry experts to always stay in the loop. Whether it’s signing up for a weekly email newsletter, following Twitter accounts, or checking in with blogs and sites from industry experts, keeping up with news as it happens is the best way to ensure you’re never caught off guard.

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2. Balancing sales vs. relationships

Next, the pressure to sell to your clients while also developing long-term relationships with them is another big challenge for health insurance professionals. Healthcare consumers expect their brokers and agents to act as a trusted advisor they can count on to find a health plan.

However, at the end of the day, you’re not just there to educate your clients—you have sales goals to meet and policies to sell so that you can stay in business. It can be tricky to know just how much time to dedicate to personal connections versus promoting your plans.

How to overcome this challenge…

A good tactic to overcome the pressure to sell while also building meaningful relationships is by working both sales and your relationships into your business goals. While you undoubtedly already have short-term sales and production goals in place, you might also consider setting long-term goals that focus on building up your clientele and improving your client relationships. By doing this, your short-term goals will help you meet sales expectations today while your long-term goals will help you grow your business into the future.

3. Communicating complex concepts

Another challenge to working in healthcare is communicating complex insurance terms and concepts to healthcare consumers who aren’t familiar with the jargon. While deductibles, copays, and premiums are terms health insurers see every day, many of your clients are totally new to them.

It’s your job to break down the vocabulary in a way they can easily understand, in addition to explaining payment processes, in-network vs. out-of-network providers, the Health Insurance Marketplaces, and so much more.

How to overcome this challenge…

It’s important to remember that much of the world today digests information in quick bits on the Internet, social media, and other digital platforms. In addition to educating your clients in the traditional ways, you might also try sharing videos, eGuides, and infographics to help make the health insurance world less intimidating. The more visual you get with your messaging, the more likely your clients will understand what you’re trying to tell them.

4. Protecting against cyber attacks

The healthcare space is chock full of data. These days, everything from health records, prescription information, and medical histories all exist in some electronic format. Health insurers collect all kinds of potentially sensitive information, making you even more vulnerable to cyber attacks and data breaches.

However, a study conducted by researchers from Michigan State University and Johns Hopkins University found that the leading cause for personal health information getting leaked isn’t hackers—it’s poor security and negligence from the health officials who were authorized to have it in the first place.

How to overcome this challenge…

If your clients ever share personal health information with you, it’s your responsibility to make sure that it’s kept safe. Implementing best privacy practices like encrypting sensitive files, staying up to date on PHI privacy rule procedures, and using a password manager to keep everything straight will help you keep your clients’ information protected.

5. Rising costs of healthcare

Finally, health insurance professionals are among the first to know when premium prices go up once renewal season comes around, making it harder and harder to help clients find an affordable plan that meets their budget.

According to a survey conducted by the Kaiser Family Foundation, 96% of the employers surveyed agree that the high costs of offering healthcare to their employees is excessive, and 87% believe the cost of providing health benefits to employees will become unsustainable in the next 5 to 10 years.

How to overcome this challenge…

Traditional group health insurance isn’t the only option brokers and insurance agents have to offer their clients. Offering a health reimbursement arrangement (HRA), especially to small and medium size organizations with limited budgets, can be a far more affordable and flexible alternative.

Through an HRA, employers simply offer a monthly allowance of their choosing to their employees who then purchase their own individual health insurance and qualifying medical expenses. Then employees submit those expenses to their employer and receive a tax-free reimbursement on their next paycheck.

Learn more about how an HRA can work for your clients’ small or medium size business

This article was originally published on April 16, 2014. It was last updated July 23, 2021.

Originally published on July 23, 2021. Last updated July 23, 2021.


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