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  • Writer's pictureAhsan Malyk

Are Health Insurance Brokers Legit?

Suppose you're one of the millions of Americans who purchase Affordable Care Act (ACA or Obamacare) medical insurance through the federal marketplace, healthcare.gov, or any state's health insurance exchange. In that case, you might be wondering who to consult for assistance. You have access to regulated health insurance agents, brokers, and exchange navigators.


In order to help you find the best source for all your health insurance needs, we will compare and contrast health insurance agents/brokers and health exchange navigators, as well as outline their advantages and disadvantages.


The navigator's function in the health insurance exchange


The navigator for health insurance helps applicants identify whether they are eligible for Medicaid or subsidies and assists them in enrollment. The navigator offers unbiased education about the exchanges and exchange health plans. Health & Human Services (HHS) approved a few optional tasks in 2020. Some navigators may do the following optional tasks:


  • helping customers with post-enrollment insurance problems

  • assisting clients in appealing eligibility (though not representing the consumer in the appeal)

  • requesting exclusions from the shared responsibility

  • Providing fundamental details about premium tax credits

  • expressing fundamental ideas about using health insurance

  • Providing specialized aid to underserved or vulnerable populations


Navigators are not permitted to suggest one plan over another or point customers in the direction of a specific plan. They can offer general information you can use to comprehend your health insurance options. Instead of insurance companies, state and federal grant programs pay navigators.


The function of a licensed health insurance broker or agent


Your shopper is a certified agent for health insurance. Additionally, he or she brings knowledge of insurance to the job. Brokers and agents for health insurance who have obtained exchange certification can also clarify plan specifics and advise customers in determining their eligibility for Medicaid or subsidies. But unlike navigators, they can also suggest plans depending on a customer's unique situation.


After the plan is purchased, health insurance agents and brokers serve their clients by assisting them in resolving any issues they may have with billing, utilization, medical claims, and appeals. Both the government-run exchange and their state's insurance department issue licenses to brokers and agents.


They must continue their education in order to maintain their licences and certificates. They must also obtain specific training on the insurance products they sell from state regulatory bodies and the insurance firms they represent. Insurance businesses pay brokers and agents in the insurance industry.


How can you choose a broker or salesperson for health insurance who will fulfil your needs?


Good brokers and agents for health insurance have knowledge. They can assist you in comprehending the goods they offer. Good health insurance brokers and agents can also stay on top of continuing regulatory developments. You want a broker or agent that will be open and honest with you about your options while assisting you in finding the insurance that best suits your needs.


Is using a broker to purchase health insurance preferable?


Brokers of health insurance are all authorized insurance representatives. However, not all brokers are health insurance agents. You should consider using a broker to purchase your insurance if possible.


Health insurance brokers typically represent one provider, selling that provider's insurance. A brokerage house may employ some.


Brokers are employed by their clients. Typically, brokers have relationships with numerous insurance providers, access to a range of medical insurance options, and, occasionally, additional insurance products. An insurance broker can assist you when filing a claim by using his or her knowledge and experience to assess your specific insurance needs, discover the greatest coverage, and find the best price.


Insurance agents typically have fewer options for health coverage than brokers do. If an insurance agent just represents one insurance company, they may not be the greatest choice for your insurance requirements.


Benefits and Drawbacks of health insurance brokers and Agents


Based on your unique circumstances, health insurance brokers and agents can assist you in finding a health insurance plan that is suitable for you. When you work with an agent to get health insurance, they can also assist you in enrolling in SHOP coverage for small businesses and private health insurance.


Typically, brokers and agents are well-versed in the ins and outs of health insurance. They can advise you on submitting claims and obtaining approvals that are problematic. They are able to assist you in making the best decision for you because they represent numerous health insurance providers.


Pros and cons of health insurance navigators


You can enrol in CHIP, Medicaid, and other healthcare exchange programmes with the assistance of a health insurance navigator. To help the state reach its enrollment targets, health insurance navigators collaborate with unions, community service organisations, and other volunteer organizations.


Working with a healthcare insurance navigator is a wise choice if you are in good health and your income is sufficiently low that you qualify for a subsidy. However, they are unable to assist you in finding insurance products that work with your tax strategy or insurance that is not offered through an exchange. They cannot assist you with applications, claims, or health savings accounts.


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