The Benefits of an Annual Insurance Review
What to expect and what questions to ask
Health insurance plans change every year. Formularies are adjusted, out of pocket cost are change, even providers networks shift. Likewise, your needs change each year, and the plan coverage you had last year may not be the best for you now.
When you ask for a yearly policy review for your health insurance, you’re taking an important step toward ensuring your coverage remains optimally aligned with your needs. A thorough annual review done by a qualified insurance broker should be comprehensive, transparent, and tailored to your specific situation.
Similar reads
In this article
- 1 Comprehensive Assessment of Current Coverage
- 2 Evaluation of Life Changes and Evolving Needs
- 3 Remember…
- 4 Transparent Discussion of Costs and Value
- 5 Market Research and Plan Comparison
- 6 Education on Healthcare Laws and Regulations
- 7 Implementation and Ongoing Support
- 8 The Value of Transparency in Broker Relationships
- 9 What questions should you be asking your broker?
- 9.1 1) Review all changes to your household size.
- 9.2 2) Are my current deductibles and premiums still appropriate, or can I adjust them to lower my cost?
- 9.3 3) How much will this plan cost?
- 9.4 4) What discounts or savings opportunities am I eligible for?
- 9.5 5) What’s new?
- 9.6 6) Are there alternative plans or options available that might better suit my current health needs or budget?
- 9.7 7) How often will you communicate with me about my policy, and how accessible are you for questions or claims assistance?
- 10 7) How often will you communicate with me about my policy, and how accessible are you for questions or claims assistance?
Comprehensive Assessment of Current Coverage
A professional health insurance broker should begin by thoroughly evaluating your current health insurance policy. This initial assessment is critical for establishing a baseline understanding of your current coverage and identifying potential areas for improvement.
The broker should review your current plan details, including premiums, deductibles, coverage limits, and network providers. They should analyze your claims history from the previous year to identify patterns of usage and potential gaps in coverage. This analysis helps determine whether your current policy is meeting your healthcare needs effectively or if adjustments are necessary. Additionally, your broker should inquire about any changes in your personal or professional circumstances that might impact your insurance requirements.
Evaluation of Life Changes and Evolving Needs
An effective yearly review should consider any significant life events or changes that occurred over the past year. Major life events such as marriage, divorce, new children, job changes, or changes in household size all affect your coverage needs and eligibility for certain plans.
Your broker should also consider any anticipated future changes or healthcare needs. They should help you proactively plan for upcoming medical procedures, ongoing treatments, or potential changes in family size that might affect your insurance requirements. This forward-looking approach allows you to adjust your coverage before you actually need it, preventing potential gaps in protection.
Remember…
All brokers have access to the same products from the same companies at the same price as anyone else. Premium cost, plan benefits, and everything else is the exact same between brokers as they are determined by the insurance company based on your age and where you live; no one broker has a better plan than another broker.
So, if a broker tells you that they have a great deal that only they have access to, they are not being truthful.
What makes one broker better than another is their attention to detail, willingness to work in your best interest, outright knowledge of different plans and options, and their continued support. Keep this in mind when you sit down for an annual review with your broker.
Transparent Discussion of Costs and Value
Premium Analysis and Budget Considerations
During your annual review, your broker should provide a clear breakdown of your current premium costs and how they compare to the previous year. They should explain any premium increases and the factors contributing to these changes, such as age-based or income-based adjustments, claims history, or market-wide trends in healthcare costs.
The broker should work with you to establish a realistic budget for your health insurance coverage, ensuring that any recommended plans align with your financial constraints while still providing valuable protection. They should help you balance cost considerations with coverage needs to find the optimal solution for your situation.
Identification of Discount Opportunities
A thorough annual review should include exploration of potential discounts and cost-saving strategies. Your broker should identify any available discounts for which you might qualify, such as wellness program participation, bundling policies, or group rates. They should also discuss strategies for maximizing your insurance benefits while minimizing out-of-pocket costs, such as using in-network providers or taking advantage of preventive care services.
Market Research and Plan Comparison
Researching Alternative Options
A competent health insurance broker should conduct thorough market research to identify alternative plans that might better serve your needs. They should stay informed about new offerings from different insurance carriers and be able to present you with a range of options beyond your current plan.
The broker should evaluate different options based on coverage details, network availability, costs, and overall quality. This comprehensive approach ensures that you have access to the full spectrum of available plans rather than just being automatically renewed in your existing coverage, or, worse, being funneled into the only plan your broker is authorized to sell.
Transparent Presentation of Choices
When presenting alternative plans, your broker should provide a comparative analysis that highlights the pros and cons of each option in a clear, easy-to-understand format. They should explain the benefits, costs, and features of each plan option to help you make an informed decision.
As of 2023, brokers must reveal any compensation they receive related to their services. This transparency allows you to understand any potential financial incentives that might influence their recommendations and ensures you can make truly informed decisions about your health insurance options.
Education on Healthcare Laws and Regulations
Your annual review should include updates on any relevant changes to healthcare laws and regulations that might affect your coverage. A knowledgeable broker should explain how recent regulatory changes impact your specific situation and what adjustments might be necessary to ensure compliance.
They should be able to answer your questions about complex healthcare regulations and help you navigate compliance confidently. This education component is crucial for empowering you to make informed decisions about your health insurance coverage.
Implementation and Ongoing Support
Facilitating Coverage Adjustments
If changes to your coverage are warranted (which, they almost always should be), your broker should handle the implementation process efficiently. They should assist with completing any necessary paperwork, submitting applications, and ensuring a smooth transition to new or modified coverage.
The broker should verify that all changes are accurately reflected in your updated policy documents and that there are no gaps in coverage during the transition period. This attention to detail prevents potential issues down the line.
Providing Continued Assistance
A quality health insurance broker continues to provide support beyond the annual review. They should remain available throughout the year to answer questions, assist with claims issues, or help you understand how to best utilize your benefits.
The broker should also help you understand how to access and use any digital tools or resources provided by your insurance carrier, such as online portals or mobile apps for managing your healthcare. This ongoing support maximizes the value you receive from your health insurance coverage.
The Value of Transparency in Broker Relationships
Recent regulatory changes have emphasized the importance of transparency in the relationship between health insurance brokers and their clients. The new disclosure requirements under the Consolidated Appropriations Act ensure that brokers reveal any compensation they receive related to their services.
This transparency is crucial because it allows you to understand any potential conflicts of interest that might influence the broker’s recommendations. When receiving plan recommendations, you should now be able to see clearly if your broker receives higher commissions for certain plans over others. This information helps you evaluate whether recommendations are truly in your best interest or potentially influenced by the broker’s compensation structure.
What questions should you be asking your broker?
Most of the questions and topics that you need to go over with your broker should already be covered by your broker. If the person you’re sitting down with doesn’t ask you these questions, you should consider finding someone new to work with.
Here is what I would consider the bare minimum in what needs to be talked about before any new plan can be recommended.
1) Review all changes to your household size.
Did you have a child born this year? Did you get married or divorced? Did a parent move in with you that you are financially responsible for? Maybe a child turned 26 and your household size decreased.
These are all very common situations that drastically affect not just your coverage needs, but also your cost. Most of these situations warrant an SEP and allow you change your plan mid-year. If you did not do this, however, make sure to cover this when reviewing your plan each year.
Remember, paying more each month for premiums usually results in paying less when you use the plan. Conversely, a lower monthly premium typically results in higher out-of-pocket cost.
Depending on how much you used your plan last year and how much you expect to use your plan the following year, there is a sweet spot between premiums and out-of-pocket cost.
3) How much will this plan cost?
Cost is more than just your monthly premiums. A good broker should be able to realistically estimate your healthcare cost for next year based on how many times you used the plan this year. Make sure your broker provides this information to you so that you understand where and when you’ll be spending your money.
4) What discounts or savings opportunities am I eligible for?
Medicare beneficiaries should look into premium assistance programs for Part D plans, and if you are dual eligible, make sure your broker understand the requirements of your specific designation.
For ACA plans, cover how much of a subsidy you received on your premiums, and your cost share subsidy on Silver plans. Also, discuss how to your income estimates can be adjusted, when they should be adjusted, and what happens if you estimate incorrectly.
This is all very basic stuff that your broker needs to know and needs to be able to explain to you.
5) What’s new?
Laws and regulations are constantly changing, and these changes can drastically change how your insurance works or what it covers. Any competent broker will stay on top of these changes; if yours does not, you should find a new broker.
6) Are there alternative plans or options available that might better suit my current health needs or budget?
If your broker has access to indemnity plans, they may recommend either adding these on as supplemental coverage, or, in some instances, using this instead of a traditional health plan.
Be wary of any broker who passes these plans off as an alternative to full health insurance; these plans are great, in some situations. Not everyone benefits from these plans and your broker should be able to explain why he or she recommends these products.
7) How often will you communicate with me about my policy, and how accessible are you for questions or claims assistance?
Part of what sets a good broker and bad broker apart is how they work for you after they have gotten paid for your plan. If your broker doesn’t return your call or email within a day, or if they won’t spend 30 minutes walking you through a form that your insurance company needs, you need a new broker.
7) How often will you communicate with me about my policy, and how accessible are you for questions or claims assistance?
A yearly health insurance policy review with your broker should be a comprehensive process that reassesses your needs, explores available options, and ensures your coverage remains optimal. The broker should take a client-centered approach, focusing on understanding your specific situation and providing tailored recommendations rather than simply pushing for policy renewal.
By conducting thorough annual reviews, your health insurance broker helps you adapt your coverage to life’s changes, identify cost-saving opportunities, and ensure you have the protection you need when you need it. With new transparency requirements in place, you can now enter these reviews with greater confidence that your broker’s recommendations are aligned with your best interests.
Regular policy reviews represent a valuable opportunity to strengthen your relationship with your broker while ensuring your health insurance continues to provide the protection and value you deserve. By knowing what to expect, you can actively participate in the review process and make the most of this important financial checkup.
If you have not had a policy review in the past year, or, if your broker is not living up to what should be expected of them, feel free to reach out and we can talk.
- Saving on prescription medications without insurance - May 15, 2025
- What Makes One Medicare Supplement Plan Better Than Another from a Different Insurance Company? - May 12, 2025
- How your health insurance subsidy is calculated - April 28, 2025
