How to Talk to Your Clients About Out of Pocket Expenses

As a health insurance agent, you are likely faced with one overarching concern every day: how to make insurance less complicated for your clients. There’s no doubt that healthcare coverage is challenging and multi-faceted; consumers likely feel overwhelmed with the laundry list of aspects they need to consider before selecting the coverage that effectively fits their needs and budgets. They depend on agents’ guidance and expertise when they’re deciding how to best protect their health (and the health of their loved ones) as well as their wallets.

Such responsibility can feel daunting, especially considering all there is to know about healthcare coverage. If you’re a new health insurance agent, you’re probably still grasping the ins and the outs and tailoring your sales approach to this ever-evolving and highly regulated industry.

Let’s take a look at some industry terminology that will help you talk to your clients about out of pocket expenses and consider how those expenses relate to short-term medical and health benefit insurance plans.


This refers to the amount your clients pay for themselves before their insurance carrier pays benefits.

If your clients are concerned about the cost of deductibles when facing common illnesses such as a cold, an ear infection, pink eye, or strep throat, they may be interested in coverage that includes a telemedicine as a feature.

Telemedicine meets patients where they are by allowing them to connect with doctors via phone, video, smartphone, or computer and reducing travel time, anxiety, and time away from family and responsibilities. This feature is available with many short-term medical and health benefit insurance plans as well as traditional healthcare coverage.


This refers to the amount your clients pay to their providers at the time of their visit. The amount may vary depending on the type of service they receive and typically does not count toward deductibles.

Affordability is certainly one of your clients’ primary concerns when choosing healthcare coverage. Many short-term medical plans offer low out of pocket copays for doctor’s office visits and wellness care. That said, clients must understand that benefits may be more restricted as well since these plans do not need to meet the 10 essential health benefits. They also do not cover preexisting conditions.

Clients who need another type of coverage and/or who may need to supplement their major medical coverage may benefit from health benefit insurance, as this type of policy may be cost effective and provides cash benefits to pay for a variety of expenses, including copays. Keep in mind that there may be limitations and/or restrictions, so be sure to fully review the circumstances under which payment can be received with your clients.


This refers to the amount your clients pay to their providers for services rendered after they pay their deductible and after their carrier covers its portion. This amount is a form of cost sharing and is in addition to the copay that is paid at the time of the visit.

Short-term medical plans offer a variety of coinsurance options, including a 100%/0% option. This can allow your clients to circumvent a coinsurance payment and would task the carrier with paying 100% of the fees.

Keep in mind that short term insurance plans do not cover preexisting conditions and are not required to cover 10 essential health benefits, including maternity and newborn care, mental health and substance abuse disorder services. Encourage clients to check any plan details carefully to understand what is covered. Health benefit insurance plans do not offer coinsurance options, as they provide fixed cash benefits for specific covered expenses.

Note: It is important to keep in mind, that while short-term and health benefit insurance coverage can provide valuable benefits, neither one is intended to be a replacement nor an alternative to ACA or other major medical plans. These types of coverage do not provide the minimum essential health benefits that are required and will not help to avoid the fee for not carrying health insurance.

Are you ready to talk to your clients about affordable coverage and features of short-term medical and health benefit insurance plans?

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Health Insurance Innovations, Inc. is a leading developer and administrator of affordable, web-based individual health insurance plans and ancillary products. We help consumers address their health insurance needs by offering access to a number of products offered by various insurance carriers.

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How to Talk to Your Clients About Out of Pocket Expenses