Insurance 101:  Insurance is Complicated, Understanding It Shouldn’t Be

Insurance 101: Insurance is Complicated, Understanding It Shouldn’t Be

Sep 30, 2016

They say those who can’t do, teach. But they also say that while we teach, we learn. In fact, Seneca said that. The Roman philosopher Seneca. (Not Seneca Crane from the recent Hunger Games films.) So which is true? Stephanie Frisch hails from a family of teachers. And she would have to agree with Seneca. “I’m always learning. I want to know everything there is to know.” In the world of insurance, the demand is high for those who are dedicated to teaching the consumer, rather than taking them simply as a commission.

What do you really know about your insurance policies? Has anyone ever sat down and explained insurance to you in a way you really understood? Medicare. Prescription drug coverage. Covered California individual family plans. The chances are about as slim as Katniss escaping the Hunger Games alive. As the owner of Insurance 101, Stephanie is taking an industry norm and turning it on it’s head.

“I come from an all-teacher family. I learned a long time ago how to properly and thoroughly inform my clients. And I believe that a personalized, caring approach is what it takes to garner trust with folks who at a base level, have no idea what the terms are, or what the provisions of the plans mean.” Specializing in senior needs - such as Medicare plans and prescription drug plans for South County residents, Stephanie is faced with unique situations daily. “As the demand grows for this type of service, I find that my successes lie in earning the trust of my clients. The actual business is just one factor. Caring for the whole person is the key.”

I’ve been told that my method of explaining insurance makes it easier to understand than any other way my clients have been told before. And I’m really trying to help them, not sell them.

Her old-school approach is unrivaled. Rarely does a broker find the time to spend one-on one with a client, let alone achieving any sort of true human interaction in the world of text messaging, multi-password online applications, and automated 800-number customer service recordings. “I keep contact information and notes from past conversations with all of my clients. When someone calls me, I see their name pop up on my phone and I greet them personally. I love helping people, and bringing a personal touch to the impersonal world of insurance is key. You can’t rush when you do what I do.” Having the knowledge and savvy to navigate the insurance world is one thing. Having the patience to wade through the headlines and get to the heart of the issues speaks to a deep desire to do right by her clients. “It’s my responsibility,” she notes.

Sifting through the sludge of government issues, printed articles, and healthcare propaganda is enough to drive any American toward feeling as if the premium they are really paying is in lifeblood, not dollars.

“What I provide is ‘value added’ to what customers pay in their insurance premium,” says Stephanie. “I don’t personally charge for my consulting service. I’ve been told that my method of explaining insurance makes it easier to understand than any other way my clients have been told before. And I’m really trying to help them, not sell them. I want to know everything about the products I offer to people and what is going on out there. 65 looks and acts a lot younger than it used to. They want the information that will help them be proactive about their lifestyle, and I help them find that.”

Be it working, traveling, parenting, surfing, running marathons, practicing yoga, or training for the next Hunger Games - you should be informed. If you’d like to understand your options and benefits better, Stephanie’s the one to call.

Question: How long have you been doing this and do you have an office?

Stephanie Frisch: I have been licensed and working this business full time since May of 2006. Initially I would make house calls and meet people in a common area. Two years ago my client base and amount of prospective clients made is necessary for me to open an office in San Juan Capistrano and have people come to me. It’s worked out very well. We can spread documents out on my desk, it’s quiet without distractions and I have access to my printer and the internet which is very important these days. I do still make house calls for my Medicare clients, many times they’re housebound or just don’t get around easily.

Question: Do you have set office hours?

SF: No, I work by appointment only. If I don’t have appointments with clients many times I work out of home. My attitude with my career is that I’m basically working 7 days a weeks at least a few hours a day. I’d never be home if I was always working out of my office.


Question: We know you work a lot with Medicare beneficiaries, is there any new information they should know about?

SF: Well a big change was to the Medicare Part B standard premium. For years it’s been $104.90 a month. Several months ago people that were new to Medicare or that were already on Medicare but not taking Social Security had a premium increase. The premium adjusted up to $121.80 a month. Also, many people aren’t aware that they will pay MORE than $121.80 a month if they make more than $85K a year as an individual or $170K as a married couple. That sometimes translates to sticker shock. I have a worksheet that I share with new Medicare beneficiaries so they’re not taken by surprise.

Question: What choices do people have during Open Enrollment?

SF: From October 15th to December 7th people with a standalone drug plan and/or a Medicare supplemental plan can shop to see what Medicare Advantage plans have to offer. This is the time for them to learn about plans that have a zero premium and include RX coverage too. If they do end up wanting to enroll in a Medicare Advantage with Prescription drug plan, they don’t need to worry about health conditions because enrollment is not subject to underwriting and is guaranteed issue (unless they have end stage renal disease). For people already on a Medicare Advantage plan, this is the time they can look at changing to another like type of plan that may be richer in benefits and/or meet their needs better than their current plan. Or, these people may want to go back to Original Medicare and purchase a standalone drug and Medicare supplemental plan. Drug formularies (the list of covered drugs in an RX plan) can change every year, so if someone is taking a lot of medications it’s important for them to be aware of any changes that may affect their out of pocket costs. The only time to change drug plans during the year without some special circumstance is during Open Enrollment.

The only time to change drug plans during the year without some special circumstance is during Open Enrollment.

Question: Do you still find a lot of confusion exists for people when they go onto Medicare for the first time?

SF: Oh, absolutely! Those consultations generally take an hour and a half to two hours. There are so many factors to cover. Many times they or their spouse may still be working, so we need to look at the cost of their current group insurance and what it covers versus what they’ll pay for Medicare. If they’re still working and their income is high, many times it’s more expensive to go on Medicare and they should wait until they retire. We have to take into account past and current income, researching doctor participation in medical networks if they want a Medicare Advantage plan, and look at what drug plan gives them the lowest copays for the medications they’re currently taking. If I’m meeting with a husband and wife we are basically going through this whole process twice.

The Insurance Marketplace and Covered California

Question: You specialize in Medicare, but you also help people with their health insurance that are under 65, what advice would you give them for their Open Enrollment that starts November 1st?

SF: Don’t try to figure it out on your own. I get paid by the insurance companies that I repre sent and it costs nothing to take advantage of my knowledge and experience. This is a very busy time for me because open enrollment coincides with Medicare open enrollment, but I’m able to help most non-Medicare prospective clients by scheduling a phone appointment or two with them and enrolling them online. The deadline enrolling in a new plan for 1/1/17 coverage is 12/15/16. The deadline for changing your current plan with your existing insurance provider for 2017 is 1/31/17.

Question: What do you think is the biggest change in insurance plans offered for 2017 for those who buy insurance from Covered California or directly from the insurance companies?

SF: Well, Anthem is going back to their 2015 model of an EPO vs. the Tiered PPO that they had last year. Any hospitals that were in Tier 2 may now be out of network and people won’t be able to access care in those hospitals. So for example, last year an Anthem Tiered PPO member could go to Hoag, Mission, St. Joseph and St. Jude hospitals here in Orange County and still be in-network, they just wouldn’t get as good of a negotiated rate as they did by going to a Tier 1 hospital such as Saddleback and U.C.I. In 2017, with the change back to an EPO plan structure, they have NO coverage out of network. It is much like a HMO, but they don’t need to have a referral to specialist, just like with a PPO. I’m told the network of doctors shouldn’t change any more than the normal shuffle, it’s just the hospital in network participation that is being affected.

Question: So are there less choices this year than last year for people?

SF: Actually as of this interview there are more. Blue Shield has decided to bring a HMO product to Orange County and Molina Healthcare is expanding their service to Orange county. I’m still waiting to see what Cigna and Healthnet PPO will do. They had very slim offerings last year and their prices were much higher than the other companies. However, they had broader networks, and for some people it’s worth it to them to be able to continue seeing their doctors.

If you’re interested in learning more about what Stephanie can do for you, contact her at (949) 351-2443. If you need help with the next stage in your life or have any questions about insurance, you can count on her to point you in the right direction.