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A Great Agent and Open Enrollment

Writer's picture: Renee BalcomRenee Balcom

Dear Community,


Happy New Year 2025! I hope this year brings you lots of happiness, good health, and success. A new year is always a fresh start, full of new opportunities and possibilities, and I’m excited to see what it brings for all of us.


As we begin the year, it’s also a good time to reflect on the routines that shape our lives, like Open Enrollment. Each year, this process raises a familiar question: “Why do we have to do this again?” As a Professional Healthcare Advocate, I wanted to explore this annual tradition and understand its purpose more deeply.


This is what I discovered from AI about Open Enrollment.


Open Enrollment gives people a fair and predictable opportunity to access or change their health insurance plans. Here are some reasons why it is necessary and beneficial:


  1. Preventing Adverse Selection

  2. Simplifying Administrative Processes

  3. Promoting Fairness

  4. Encouraging Planning and Responsibility

  5. Regulatory Compliance

  6. Aligning Employer and Marketplace Coverage

  7. Providing Flexibility Through Special Enrollment


In short, Open Enrollment balances the need for access, market stability, and efficient administration while protecting the system from misuse.



So, we agree that Open Enrollment is necessary to ensure an even playing field in the insurance industry. By navigating this opportunity, we can anticipate and determine our insurance needs for the upcoming year as best as possible. But insurance is multi-layered and complex. Navigating the intricacies of Open Enrollment requires preparation and understanding. Individuals should review current coverage, assess healthcare needs for the upcoming year, and compare available plans. Factors such as monthly premiums, out-of-pocket costs, provider networks, and prescription drug coverage should all be carefully evaluated.

 

I cannot imagine trying to navigate this maze without the help of a trusted insurance professional.

 

An insurance agent can be beneficial for several reasons, depending on your needs and familiarity with the insurance process. All the Professional Healthcare Advocates at Renee & Company feel receiving this critical counsel from a licensed professional is vital—someone eager to get acquainted with your needs and budget.

 

Agents provide guidance. An insurance agent offers expert guidance and assists you in reviewing and understanding the plethora of complex options. They also help tailor your policy to suit your specific needs, budget, and goals, ensuring you are not overpaying for unnecessary coverage or missing out on critical protections.

 

Agents save you time. Your agent will do all the work. Their licensing requires them to be current on all the newest laws and regulations governing insurance in the state they serve. They are the professional representatives of the insurance carriers they work with. And, in most cases, like any trusted professional advisor, they will work to locate any information they do not know.

 

Agents advocate for you. Your agent acts as your advocate with the insurance company. If you need to file a claim or a claim has been denied, or encounter any problems, they can see on the other side of the Bot Curtain, expedite the process, provide guidance, and resolve disputes.

 

This relationship is as important as any of the professionals you have in your support arsenal. Maybe even more critical than most because you may use your insurance more than any other services you pay for. Working with an agent gives you access to someone who can answer your questions, address concerns, and adjust your policy as your needs change. Their professional guidance provides peace of mind by guiding you through the process and ensuring you have appropriate coverage for your unique situation.

 

I have to be fully transparent here —I have the honor of serving on the Board of Directors for the Northern California Chapter of California Agents and Insurance Professionals. No, I am not an insurance agent; I am a professional healthcare advocate, and I chair the DEI initiative of CAHIP. My relationship with this organization has educated me about the merits of the insurance profession. I have learned why we, as consumers, need this representation and the support of these dedicated and trusted individuals. In my opinion, these are underutilized resources, and if we want to take full advantage of the money we spend on our insurance, these are our allies.

 

However, insurance carriers are beginning to diminish the income of insurance brokers by refusing to pay for particular insurance coverage. In 2025, significant changes were proposed and implemented regarding insurance agent commissions, particularly in the Medicare Advantage (MA) and Part D prescription drug plan markets. Although the courts put these changes on hold for now, your trusted agent will inevitably not go unscathed.

 

The unfortunate public response to the shooting of the CEO of United HealthCare, Brian Thompson, opened our eyes to the sense of unjust treatment that is felt by so many people in the United States by their insurance carriers. This heinous act could not be justified, but the emotional response to this crime seemed to have some merit, or at the very least, it gained some traction in our communities.

 

Our call to action is clear: We must be able to rely on these crucial professionals for guidance and assistance as we navigate the complexity of insurance coverage. Ensure you communicate appreciation for your insurance agent as you interface with your insurance carrier. Make sure your agent knows how much you appreciate them as well.

 

Here's to great coverage,

Renee Balcom


 


If we can assist you further, contact Renee & Company at 844-661-2369 or renee@reneecompany.com




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