Both health insurance agents and government navigators can help you enroll in coverage—but they work differently. Here's what you need to know about each option and which may be right for you.
Finding the right health insurance plan can be overwhelming. Between understanding plan types, comparing costs, and navigating enrollment periods, many people benefit from professional help. Two main options exist: licensed health insurance agents and government-funded navigators.
Our local health insurance agents provide specialized guidance to North Carolina residents. We help people every day by learning about their needs so they can select the right coverage.
Navigators, in comparison, are funded by state and federal grant programs. They cannot accept compensation from health insurance companies or provide advice about which specific plans you should choose.
In February 2025, the federal government announced a 90% reduction in Navigator program funding—from $100 million for the 2025 plan year to just $10 million for 2026. In North Carolina specifically, Navigator funding was cut from approximately $7.4 million to $750,000.
This means significantly fewer navigators will be available to help consumers during the 2026 open enrollment period and beyond. Many navigator organizations have had to reduce staff or limit services. As a result, licensed insurance agents have become an even more important resource for people seeking enrollment assistance.
There are important similarities and differences between licensed health insurance agents and government exchange navigators.
Similarities
No cost to you: Whether you work with a navigator or a licensed insurance agent, both offer their services at no direct cost to you. Navigators are paid through government grants, while agents are compensated by insurance companies when you enroll in a plan.
Assistance with applications: Both can help you apply for premium tax credits (subsidies) through the Health Insurance Marketplace. Licensed agents authorized to process Marketplace applications can handle your subsidy application—check with your agent to confirm they offer this service.
Help with enrollment: Both licensed agents approved for Marketplace enrollment and navigators can help you enroll in subsidy-eligible health plans.
Key Differences
Personalized recommendations: Only licensed health insurance agents can recommend specific plans based on your needs. Navigators can help you compare plans and understand your options, but they are prohibited from advising you to choose one plan over another.
Range of insurance options: Navigators can only help with plans offered through the Health Insurance Marketplace—they cannot provide information about private insurance options outside the exchange. Licensed agents authorized to enroll you in the Marketplace can advise you on both Marketplace plans and off-exchange options, giving you a complete picture of your choices.
Medicaid and other programs: Navigators often help people enroll in Medicaid when they're found ineligible for Marketplace coverage. According to KFF research, navigators are more than twice as likely as agents to help consumers sign up for Medicaid or CHIP (88% of navigator programs vs. 39% of brokers).
Availability: Due to 2025-2026 funding cuts, navigator availability is significantly reduced. More than 64,000 Marketplace-registered agents and brokers are available to help consumers nationwide, while navigator organizations have faced staff layoffs and service reductions.
Licensing and oversight: In many states, including North Carolina, licensed health insurance agents must pass exams, complete continuing education, and undergo background checks to maintain their licenses. Navigator requirements vary by state but typically involve federal training and certification, with no uniform licensing standards.
Ongoing relationship: Licensed agents often maintain relationships with clients year after year, helping with questions about claims, benefits, and coverage changes. Navigator services are typically focused on the enrollment period.
Working with a licensed health insurance agent ensures you've considered all available options—not just those on the Marketplace. Knowing you've explored the full range of choices can give you confidence that you're getting the right coverage for your budget. Benefits of working with an agent include:
Expert guidance on terminology: Agents can explain industry jargon like deductibles, coinsurance, out-of-pocket maximums, and metal tiers in plain language.
Right-sized coverage: An agent assesses your healthcare needs and budget to recommend plans that actually fit—not just the cheapest option or the most expensive.
Subsidy expertise: Agents can help you understand the complexities of Premium Tax Credits, including how income changes affect your subsidy and important 2026 changes to repayment rules.
Multi-carrier comparison: Agents can compare prices and plans across multiple insurance companies, helping you find the best value.
State-specific knowledge: A local NC health insurance agent understands North Carolina's insurance market, including which carriers offer coverage in your county and which provider networks are strongest in your area.
Year-round support: Agents build relationships with clients and can help throughout the year with questions about claims, benefits, life changes that trigger special enrollment periods, and annual plan reviews.
Medicare expertise: If you're approaching 65 or already on Medicare, many agents also specialize in Medicare Advantage, Medigap, and Part D plans—coverage navigators cannot help with.
Navigators can be a good option in certain situations:
You may qualify for Medicaid: Navigators are well-equipped to help determine Medicaid eligibility and assist with enrollment if you don't qualify for Marketplace coverage.
You want completely unbiased information: Since navigators don't receive commissions, some people prefer their impartial approach to presenting options.
Language or accessibility needs: Navigator programs are required to meet cultural competency standards and often provide multilingual assistance to diverse communities.
Keep in mind: Due to significant funding cuts for 2026, navigator availability is limited. If you need help during open enrollment, don't wait—reach out early or consider working with a licensed agent who can provide similar assistance plus personalized recommendations.
To find a navigator: Visit LocalHelp.HealthCare.gov and enter your ZIP code. Filter for "assisters" to see navigators and certified application counselors in your area.
To find a licensed agent: Contact a local health insurance agency directly. In North Carolina, our agents are available to help you compare options, understand your choices, and enroll in the plan that's right for you.
If you like to compare your options before making decisions, working with a licensed health insurance agent is a wise choice. Our Medicare agents in Charlotte, NC, and health insurance agents in Raleigh, NC—along with agents throughout North Carolina—can help you:
Rule out options that don't fit your needs
Recommend plans that match your healthcare needs and budget
Apply for premium tax credits and cost-sharing reductions
Enroll in the right Marketplace or private plan
Navigate Medicare options when you're eligible
