If you are one of the millions of Americans who uses the federal marketplace, healthcare.gov, or your state’s health insurance exchange to purchase Affordable Care Act (ACA or Obamacare) medical insurance, you may be wondering whom you turn to for advice.

In this article, we will explore the distinct roles of health insurance agents/brokers and health exchange navigators. Understanding the responsibilities and advantages of each will empower you to make informed decisions when seeking appropriate health insurance coverage. By the end of this discussion, you will be better equipped to choose the most suitable resource to address your specific health insurance requirements.

The role of the licensed health insurance agent or broker

All health insurance brokers are licensed insurance agents. But not all health insurance agents are brokers.

What is a health insurance agent?

A licensed health insurance agent is your personal shopper. And he or she brings insurance expertise to the task. Generally, health insurance agents work for an insurance company selling that one company’s insurance. Some may work for a brokerage firm.

What is a health insurance broker?

Brokers work for their clients. Usually brokers work with a number of different insurance companies, have access to a variety of medical insurance plans, and sometimes other insurance products as well. An insurance broker uses his or her knowledge and experience to help you assess your unique insurance needs, find the best coverage and value, and can assist you when making a claim.

Brokers can offer you more choice in health coverage and plan options than insurance agents, generally. An insurance agent who works for an insurance company only sells that company’s products, which may not be the best fit for your insurance needs.

Is it better to use an insurance agent or broker?

The choice between using an insurance agent or broker depends on individual preferences and needs. Both can be valuable resources for finding suitable insurance coverage, so consider factors like personal preferences, complexity of insurance needs, and level of assistance desired when making your decision.

How are insurance agents and brokers similar?

Health insurance brokers and agents who are certified by the exchanges can also explain plan details and help consumers determine subsidy or Medicaid eligibility. They can also make plan recommendations based on a consumer’s particular circumstances to get the most out of your insurance.

Health insurance agents and brokers continue to assist their clients after the plan is purchased, helping them resolve questions and problems regarding billing, utilization, medical claims, and appeals. Brokers and agents are licensed by their state department of insurance as well as certified by the government-run exchange. Not only must they receive specialized training in the insurance products they sell from state regulatory agencies and insurance companies they represent, they must continue education to keep their licenses and certifications. Insurance agents and brokers are paid by insurance companies.

How are insurance agents and brokers different?

Insurance agents and insurance brokers are both professionals who help individuals and businesses find and purchase insurance policies. However, they differ in several key aspects:

1. Representation:

• Insurance Agents: Agents typically work for specific insurance companies and represent those companies when selling policies. They have in-depth knowledge of the products offered by the company they represent and can provide detailed information about their policies.
• Insurance Brokers: Brokers, on the other hand, work independently and are not tied to any specific insurance company. Instead, they work for their clients and represent their interests. Brokers have access to a wide range of insurance products from different companies, allowing them to offer more diverse options.

2. Product Range:

• Insurance Agents: Agents can only offer insurance policies from the company they work for. While they may have a variety of plans within that company’s offerings, they are limited to what their company provides.
• Insurance Brokers: Brokers can offer a broader selection of insurance products from multiple insurance companies. This gives clients more choices and the potential for finding a policy that better matches their specific needs.

3. Commission Structure:

• Insurance Agents: Agents earn commissions from the insurance company for each policy they sell. As a result, their income is directly tied to the policies they sell for the company they represent.
• Insurance Brokers: Brokers also earn commissions from insurance companies, but since they work independently and have access to various insurers, they may have more flexibility in their commission rates. Some brokers may charge a fee for their services, while others rely solely on commissions.

4. Advocacy and Advice:

• Insurance Agents: Agents are knowledgeable about the products offered by their company and can provide guidance on selecting policies from their specific offerings. However, their recommendations are limited to the products available from their employer.
• Insurance Brokers: Brokers act as advocates for their clients and provide unbiased advice since they are not tied to any particular company. They can assess a client’s needs and preferences and then recommend the most suitable policies from a broader market.

Choosing an Insurance Agent or Broker:

• Insurance Agent: If you prefer to work with someone who specializes in a specific insurance company’s offerings and has in-depth knowledge of those products, an insurance agent might be a good choice. Agents can be particularly helpful if you have a clear preference for a specific insurance company or if the agent’s company has policies that precisely fit your needs.
• Insurance Broker: If you value having a wide range of options and impartial advice, an insurance broker may be the better option. Brokers can compare policies from different insurers and tailor their recommendations to match your unique requirements. Additionally, if you find the insurance market complex and want someone to guide you through the process, a broker’s expertise can be invaluable.

Ultimately, the decision between using an insurance agent or broker comes down to your individual preferences, the complexity of your insurance needs, and the level of personalized assistance you desire.

Health insurance brokers and agents: Pros and cons

Health insurance brokers and agents can help you find a health insurance plan that is right for you based on your specific needs. When you use an agent to buy health insurance, they can also help you sign up for private health insurance coverage and for SHOP coverage for small businesses. 

Brokers and agents usually have in-depth knowledge of how health insurance works. They can give you advice on filing claims and problem approvals. They represent multiple health insurance companies, so they can help you find a good choice that’s right for you.

Health Insurance Brokers and Agents Shared Pros:

• Expertise and Knowledge: Both brokers and agents possess comprehensive knowledge of health insurance policies, regulations, and the healthcare industry. Their expertise allows them to guide you through the complex process of selecting a suitable plan based on your specific needs.
• Access to Multiple Options: Brokers and agents represent various health insurance companies, giving you access to a wide range of insurance plans. This broad selection increases the likelihood of finding a policy that aligns with your requirements and budget.
• Personalized Assistance: They offer personalized assistance, taking into account your unique circumstances, health conditions, and preferences to recommend the most suitable coverage options.
• Claims Support: Brokers and agents can provide valuable advice on filing claims and navigating through the sometimes complex process of obtaining approvals.
• Enrollment Help: They can assist you in enrolling in both private health insurance plans and, for small businesses, the Small Business Health Options Program (SHOP) coverage.

Health Insurance Brokers Pros:

• Impartial Advice: Brokers are independent and work for their clients, not insurance companies. Their impartiality allows them to prioritize your needs and recommend the most appropriate plans from a diverse pool of insurers.
• Negotiation: Brokers can negotiate with insurance companies on your behalf, potentially securing better rates or policy terms.
• Time-Saving: With access to multiple insurers, brokers can quickly compare various plans, saving you time and effort in the research process.

Health Insurance Agents Pros:

• Company-Specific Expertise: Agents have specialized knowledge about the insurance products offered by the company they represent. If you have a strong preference for a particular insurance provider, is a great reason as to why you would use an insurance agent can guide you through their offerings.
• Direct Support: Agents often provide direct support for policyholders, including answering questions, addressing concerns, and helping with policy management.

Health Insurance Brokers and Agents hared Cons:

• Potential Conflicts of Interest: While brokers aim to act in your best interest, some may still be incentivized by commission rates offered by certain insurance companies, potentially influencing their recommendations.
• Not All Brokers and Agents are Equal: The quality of assistance can vary among different brokers and agents, so it’s essential to choose a reputable and trusted professional.

It’s essential to weigh the shared pros and cons as well as the individual strengths of brokers and agents when deciding which professional to work with for your health insurance needs. Whether you choose a broker or an agent, enlisting the help of a knowledgeable and experienced professional can significantly simplify the process of finding the right health insurance plan for you.

Qualities of a good health insurance agent or broker

Good health insurance agents and brokers are knowledgeable. They can help you understand the products they sell. Good health insurance agents and brokers can also keep up with the ongoing changes in regulations. You need a broker or agent who will help you find the coverage that best meets your needs and will be honest with you about your choices.

What does a health insurance agent do?

Licensed agents play a crucial role in assisting consumers with their health insurance needs. They are responsible for helping individuals apply for government subsidies to purchase health insurance and providing guidance on health insurance plans available through government exchanges. These agents undergo training specific to the state exchanges they operate in and are required to be licensed by the state they conduct business in. Before working with consumers, they also undergo criminal background checks to ensure trustworthiness. Additionally, licensed agents recommend insurance plans tailored to a person’s healthcare requirements and financial budget, drawing on their expertise demonstrated through strict licensure exams. They are equipped to explain the benefits covered in plans not sold on government exchanges and can advocate on behalf of customers with insurance companies post-enrollment.

However, there are certain tasks that licensed agents do not handle. They do not facilitate enrollment in Medicaid and CHIP programs. Moreover, their services do not incur additional costs when enrolling in a health insurance plan. Despite these limitations, licensed agents remain valuable resources for individuals seeking comprehensive guidance and support when navigating the health insurance landscape.

How to find a health insurance agent or broker

When it comes to navigating the complex world of health insurance, having a trusted agent or broker by your side can make all the difference. But how do you go about finding the right one for your needs? We’ve got you covered with some handy tips on where and how to find a health insurance agent or broker:

1. Online Search: In this digital age, the internet is your best friend. Start by conducting a simple online search using keywords like “health insurance agent near me” or “health insurance broker in [your location].” This should pull up a list of professionals in your area that you can explore further.

2. Referrals: Don’t underestimate the power of word-of-mouth recommendations. Reach out to friends, family members, or colleagues who have recently purchased health insurance. Ask them about their experiences with their agents or brokers and if they would recommend them.

3. Professional Associations: Many reputable agents and brokers are affiliated with professional associations such as the National Association of Health Underwriters (NAHU) or the National Association of Insurance and Financial Advisors (NAIFA). These organizations often have directories you can search through to find licensed professionals in your area.

4. Insurance Companies: Sometimes, the simplest solution is to go straight to the source. Many insurance companies have in-house agents who can assist you with purchasing their policies. Reach out to the insurance companies you’re interested in and inquire about their agent services.

5. Local Events: Keep an eye out for local events or seminars hosted by insurance professionals. These events are not only educational but also provide an excellent opportunity to network and connect with agents or brokers face-to-face.

Remember, finding the right health insurance agent or broker is a crucial step in securing the coverage you need. Take your time, do your research, and don’t hesitate to ask questions. With the right guidance, you’ll be well on your way to finding the perfect partner to navigate the world of health insurance with confidence.

What is a health insurance exchange navigator?

Health insurance navigators can help you sign up for CHIP, Medicaid, and other healthcare exchange plans. Health insurance navigators work with community service organizations, unions, and other civic service groups to help meet state enrollment goals.

A healthcare insurance navigator is a solid option if you are in good health and your income is low enough that you get a subsidy. But, they can’t help you find policies that fit in with your tax planning and they can’t help you find a policy that is not on the exchange. They can’t help you with claims or approvals or health savings accounts.

What does the exchange navigator do?

The health insurance navigator provides impartial education about the exchanges and exchange health plans, helping applicants determine whether they qualify for subsidies or Medicaid, and assisting them in the enrollment process. In 2020 Health & Human Services (HHS) approved certain optional duties. Optional duties some navigators may perform include:

• Assisting consumers with post-enrollment coverage issues
• Helping consumers file eligibility appeals (though not representing the consumer in the appeal)
• Filing for shared responsibility exemptions
• Providing basic information regarding premium tax credits
• Communicating basic concepts related to using health coverage
• Providing targeted assistance to vulnerable or underserved populations

Navigators can’t recommend one plan over another or direct consumers towards a particular plan. They can provide general information that you can use to understand what health coverage is available to you. Navigators are paid by state and federal grant programs, not by insurance companies.

Find a Health Insurance Agents or Brokers Near You

As an insurance brokerage firm, eHealth is committed to helping you find affordable health insurance that meets your personal circumstances. Working with an eHealth health insurance agent or broker can help get you the insurance you need at the best price. We deal with a wide range of types of health insurance and services. And we have the qualifications needed to recommend the policies that best suit your needs – ACA medical coverage through the government-run exchange, ACA- compliant coverage off the exchange, short-term policies, medical indemnity plans, and more.

Take a closer look. We invite you to explore some of the many types of plans available through eHealth and our licensed health insurance agents and brokers. Simply click here: Individual & Family Health Insurance.