Whether you support it or not, the 2012 election results have solidified the Affordable Care Act as the law of the land. As the nation moves forward with implementation of this mammoth shift in how health insurance coverage is acquired, individuals, families and employers will face a myriad of decisions and choices that could have a profound effect on their futures.

While each state will have an online health insurance exchange, their existence will not lessen the complexity of considerations that purchasers must make to ensure that what they purchase meets the medical, financial and regulatory requirements they will face.

Individuals and families face decisions that will not only affect their physical well-being but also determine their ability to avoid financial devastation from unexpected health care costs.

Consumers may ask: What does the coverage mandate mean for me and my family? If I pay the penalty rather than purchase coverage, how will I get my health care?

Is there a better plan that meets my needs that I can purchase outside of an Exchange? What are my options if I can’t afford coverage and don’t qualify for a subsidy?

Similarly, employers must consider whether to keep a grandfathered plan or purchase another; whether to purchase within the Small Business Health Options Program (SHOP Exchange) or look elsewhere; and what is necessary for their company to meet the affordability standard, deductible restrictions and avoid penalties.

It’s unlikely that government-run call centers will offer the level of personal service, policy knowledge, objective guidance and accountability that most will seek in weighing the complex decisions that could well determine the course of an individual’s life or the viability of a company. Surveys show that consumers overwhelmingly prefer personalized service and human interaction with insurance providers.  

Many will need and should seek the services of licensed professionals to direct them through what can be an overwhelming maze of complex choices.

An agent that is knowledgeable and specializes in health insurance will help ensure that purchasers of coverage will receive the best advice in order to make the smartest financial decision for their circumstances.

Policymakers should recognize and protect the agent community’s ability to provide critical guidance during this transformational period.

Changes should be made to the health law’s medical loss ratio requirements to ensure individuals and employers have access to professional health insurance agents.

And consumers should consider the cost benefits and security of knowing they’ve enlisted a licensed and seasoned benefits professional to help make these critical decisions.

In their historic role as benefits advisers, professional health insurance agents can become your most valuable resource within the health care coverage system.


Kelly Fristoe is a Wichita Falls-based health insurance broker and President of the Texas Association of Health Underwriters.