Most people don't know your health insurance agent represents you NOT the health insurance company. The first priority of the health insurance agent is to explain health insurance or Medicare to the consumer. The second priority is to share with you all of your available options helping you select a plan that meets your personal needs. Once your policy is in place it is your agent's job to take care of your customer service needs. The insurance carriers pay the agent a commission to provide you with that service.
Health insurance companies announced late 2015 they will not pay health insurance agents to assist consumers with their health plan options outside of open enrollment.
Health Insurance isn't any less confusing outside of open enrollment. In fact it may be more confusing. There are many reasons to need assistance with enrollment in a health plan throughout the year. Some of those are a move, marriage, birth of a child, loss of coverage from a job.
Insurance carriers are seeking ways to discourage high cost consumers from enrolling in their health plans. Their rational is that these consumers that sign up during a special enrollment period cost them more on average. They further suggest that people that enroll during a special enrollment period are abusing the process and waiting to enroll when they get sick.
Cover California is considering rules that will allow consumers to seek guidance from a licensed insurance professional throughout the year. Perhaps the Federal Exchange (Healthcare.gov) will also see the value of consumer assistance and personal services.
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