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North Hills Monthly

Finding the Right Insurance Coverage Made Much Easier through HealthMarkets

Jul 29, 2020 05:38PM ● By Vanessa Orr

Kim Santillo, a HealthMarkets’ licensed insurance agent. Photography by Dena Koenig Photography

Shopping for health insurance is a challenge—there are hundreds of plans from which to choose, many have different deductibles and co-pays, and some of them limit what doctors you can see. And while most of us—especially those taking advantage of the Affordable Care Act (ACA)—struggle with making this decision every year, it’s even more difficult for those dealing with the loss of a job and employer-provided health insurance because of the pandemic.

HealthMarkets, a national insurance broker with more than 3,000 local agents, can help individuals and small businesses with their health insurance needs. And best of all—their services are free.

“People come to us because we can put together a custom-designed health care package to meet their specific needs,” explained Kim Santillo, a HealthMarkets’ licensed insurance agent. “While we do sell health insurance, what we are really selling is our process.”

The Initial Visit

The best way to tailor-make a plan is to truly understand an individual’s needs. To do this, Santillo sits down with each client and goes through a list of questions that provide an in-depth view of that person’s life. While appointments are normally done in person, they can also be done as a Zoom meeting to allow for social distancing.

“For the first 15 minutes, we talk about how our process works, and what we’ll be doing in our time together,” said Santillo. “Then we go through a list of questions that helps uncover what an individual really needs—everything from a family health history to what they want their final plan to look like. All of these little pieces add up and help us create the best product.”

The result is a customized health insurance plan that can include a number of factors, ranging from life insurance products to vision and dental coverage, to cancer care and accident products, to heart attack and stroke coverage and more. 

For those clients hoping to save money by signing up through the ACA marketplace, HealthMarkets not only assists them in applying for coverage, but also in determining whether they are eligible for a subsidy and in what amount, so they know the true cost of their plan before moving forward.

“Our system includes using the formula that the government sets, so we know right away if a person qualifies and how much they’ll save,” said Santillo. “This can be pretty eye-opening for people who see plans they think they can’t afford, but then realize they can because of the subsidy.”

One of the company’s goals is to help educate people about the marketplace and how the ACA works, adds Santillo. “It has a number of nuances, and it’s pretty challenging to figure out how it’s set up. If someone goes online to find a plan on the marketplace, they quickly realize that it’s a very difficult process to understand, and the application process is even more complicated.

“People who have had employer-provided insurance are used to having the Human Resources department give them two options,” she continued. “If they come to us and say they want a UPMC plan, depending on their needs and budget, we can design 50 to 100 plans.”

The Local Advantage

While many markets across the nation have a wealth of different carriers from which to choose, western Pennsylvania is a little different. 

“If you look at HealthMarkets on a grand scheme, you’ll see a lot of national carriers. But in western PA, the market is heavily dictated by regional players,” said Santillo. “Most everyone we meet asks for Highmark or UPMC plans, depending on which they’ve used before.”

In addition to going through HealthMarkets’ own training program, its brokers also attend vendor trainings, such as those provided by UPMC and Highmark, so that they are up-to-date on the latest insurance products being offered. 

“We invest a lot of time in trainings to keep up with the newest products and services and to learn how to navigate the nuances of different plans,” said Santillo.

As local agents, HealthMarkets’ brokers can also help with any concerns about a plan. “If you have any issues, you can talk to us versus calling an 800 number,” Santillo said. “We are here as a local resource, and clients don’t pay extra for this guidance.”

HealthMarkets’ agents also do a yearly reevaluation of clients’ plans, sharing information on new products and updating plans as people’s lives change. “A lot of people don’t think about how life changes may affect their insurance needs, but we do; that’s why we contact them each year to make sure that they are in the right plan and ready for open enrollment in November,” said Santillo of the concierge-style service.

HealthMarkets also works with small businesses who want to offer employee coverage and reviews the tax advantages with clients before they  choose a plan.

With so much changing because of the pandemic, HealthMarkets is a valuable resource for those who suddenly find themselves in an unfamiliar world. 

“A number of people who have been furloughed during the pandemic are just now getting letters telling them that their companies aren’t bringing them back,” said Santillo. “Up until this point, the company was keeping their insurance coverage, but now the employees are discovering that they have to get their own plans and that COBRA is a lot more expensive than they thought.

“The good news is that because of the pandemic, these people are eligible for a special enrollment period if they lost coverage because of a job loss or change,” she added. “And we’re here to help them find the right plan.”

Santillo recommends that people contact HealthMarkets sooner rather than later, as the company gets extremely busy as open enrollment time approaches. To learn more, call 724-355-7604 or visit https://www.healthmarkets.com/local-health-insurance-agent/ksantillo/

HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency in all 50 states and the District of Columbia. Not all agents are licensed to sell all products. Service and product availability varies by state.