3 opportunities in the health gap market

About the best thing you can say about selling individual major medical insurance right now is that selling it is an exciting way to generate dental leads.

Wes Thompson is taking a different approach: He’s started a web-based store, Emerge.me, that now offers critical illness insurance and accident insurance. Eventually, he hopes to add hospital indemnity insurance.

Related: 3 ways to make ACA uncertainty lemonade for 2017

In other words: Thompson has set up an exchange that highlights the supplemental health salad and the apple pie rather than the major medical hamburger.

By using the web to reach more prospects, simplify and speed up the sale process, he may be able to generate enough commission revenue to compensate for the fact that per-sale commissions are, naturally, lower than major medical commissions used to be, before everything went to heck.

Thompson has years of experience in individual product distribution. In the 1990s, he built an independent brokerage distribution system for Cigna’s life division. In recent years, he was president of Sun Life Financial Inc.’s Wellesley Hills, Massachusetts-based U.S. division, where he got into employee benefits and voluntary benefits distribution.

He began to think harder about something unsettling: the holes in consumers’ defenses against out-of-pocket health care expenses.

“More individuals are moving toward higher and higher deductibles,” Thompson said in a recent interview. “Those out-of-pocket expenses have really translated into increasing debt.’

Here’s a look at three opportunities Thompson sees in the growing coverage holes.

Thompson says many consumers need to understand how much health exposure they really face. (Photo: Thinkstock)

1. Helping consumers see the health care cost protection gaps

From the 1980s through the late 1990s, the big idea in U.S. health care cost management was to put the patients in the hands of a primary care gatekeeper.

The gatekeeper would get a capitation fee, or flat fee per month per patient served. In return, the gatekeeper would try to keep the patient healthy, and accept financial responsibility when the patient needed specialist care or hospital care.

That system broke down when patients erupted in fury over the idea of primary care physicians blocking their access to other health care providers.

Now, health plans focus on two major methods for controlling costs. One is shifting to narrower, more deeply discounted provider networks. The other is shifting more costs to the patients.

“That’s been accelerating,” Thompson said.

For consumers, one huge problem with that shift is that many have no idea what a deductible is, let alone what having a high deductible could mean for their health care spending.

Thompson sees that as an opportunity to win consumers over by helping them understand their coverage gaps.