Navigating the Health Insurance Marketplace

Insurance agents play a vital role in helping individuals and businesses wind their way through this complex process, according to Kathy Gadinas, president of Columbia Benefit Solutions.

Insurance agents (also known as brokers, consultants, or producers) have an important role in the health insurance marketplace, and have become more important with enactment of the Affordable Care Act.

It was already difficult for people who weren’t covered by employer-sponsored insurance to navigate the individual insurance market, but now there are even more complicated issues to understand, such as mandated coverage, tax credits, open enrollment, penalties, and Cover Oregon.

Kathy Gadinas, president of Columbia Benefit Solutions in Lake Oswego, has been in the insurance industry for over 30 years and has seen the industry change as the implementation of healthcare reform has redefined the way business is done. 

The challenge began, she said, when all the new rules and regulations came out following passage of the ACA. Her agency represents at least 11 insurance companies in the Portland metro area. 

Agents not only need to understand the ACA, but have familiarity with the insurance company's products and how they interpret certain provisions of that law. For the average consumer, the complexity of the products and the rules is overwhelming and can be discouraging.  That’s where agents come in.

“In order for the ACA to really work, everyone must be covered," said Gadinas. And, most people think they have to pay an extra fee by going to an insurance agent, which isn’t true.

“We get paid by an insurance company if we sell their policy,” Gadinas explained. “Some insurance companies pay per applicant, others it's a percentage of the premium.  However, the premium for the client is the same whether they use an agent or not.  So if it doesn't cost anything extra, why not call an agent?" 

Last year, the Oregon Association of Health Underwriters put together an "Agents are the Answer" campaign last year to help consumers find agents in their area.

Now, even with all the changes brought by the ACA, the one thing that hasn’t changed is that agents simply want to help people.

“We’ve always worked that way,” Gadinas reflected. “Agents do their best to find a plan that fits a client’s needs. There is always going to be a need for agents.”  

So, if a consumer is interested in speaking with an agent, what’s the first step?

"We ask clients to explain their needs to us. Do you have certain medical providers that you want to continue to see?  What’s your budget?"  Gadinas advises. “If we know what our clients need, we are better able to narrow down their choices to the plans that fit their needs."  

After purchasing an insurance plan, people should make certain their providers are inside the network and shop around for the best prices. For example, the cost of an MRI varies by clinic.  Consumers should verify that the clinic is a preferred provider and, if so, should ask how much it will cost.

Ultimately, Gadinas said, agents are a resource for the consumer, a voice for the insurance companies to help explain their products, and a communicator for government about health reform legislation.


Joanne can be reached at [email protected]

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