Do You Need To Use A Health Insurance Agent?

By Health Plans of NC Staff

Many people find aspects of shopping for health insurance confusing. There are multiple options for medical health insurance available through both the Health Insurance Marketplace and private insurance agencies. You may also have heard of the roles of “health insurance agents” and “government navigators.” If you are unaware of navigators, people engaged in this occupation are paid by state and federal programs and are not allowed to accept compensation from health insurance companies. If you are unclear about these terms and the roles of those who work in these capacities, you aren’t alone.

What are the similarities among agents and navigators?

A licensed health insurance agent and a government exchange navigator, though distinct things, do engage in similar activities. Here is a list of similarities:

  • No cost to you. Regardless of whether you work with a government exchange navigator or a licensed insurance agent, you will pay nothing for their time or support.
  • They can provide help with applying for government subsidies. Both government “navigators” and licensed insurance agents who are authorized to process subsidy applications can help you with this. Your ability to obtain subsidies for health insurance through the Health Insurance Marketplace will depend on how much money you expect to make. These subsidies can help you obtain health care coverage without overextending your budget.
  • They can help you enroll in subsidy-eligible health care plans. Again, so long as you are working with a licensed agent who is approved to process subsidy applications, both licensed agents and government navigators can support you through this process.

What are the differences between agents and navigators?

Now that you understand the similarities in these two roles, I’m sure you’re left wondering what the differences are.

  • Licensed health insurance agents are allowed to recommend specific plans which can help you meet your individual needs. Navigators, however, are not allowed to provide you with specific recommendations. While navigators can help you make comparisons between plans, they can not offer advice.
  • Navigators can only help you with health insurance plans offered through the Health Insurance Marketplace. If you are interested in exploring the whole range of health insurance plans available for your consideration, you may wish to work with a licensed health insurance agent who has authorization to process Marketplace plans. Government paid navigators aren’t allowed to present private insurance options to you.
  • You may feel more comfortable with a licensed health insurance agent if you live in a state where licensed health insurance agents are required to undergo a criminal background check. Navigators do not undergo background checks.

Why use an insurance agent?

  • An agent can help you make sure you’re getting the amount of coverage you need to cover your health care challenges.
  • An agent can help you understand the jargon associated with the health insurance field.
  • An agent understands the complexities of the Premium Tax Credit many consumers are eligible for.
  • Working with an independent agent gives you someone to help you compare prices and plans across multiple health insurance companies.
  • Licensed agents are state specific.  Working with a local agent allows you to work with someone with awareness of needs and networks specific to your area.
  • Working with an agent means you have someone you’re familiar with who can help with life changes, plan changes, and claim and benefit questions.

If you are a shopper who likes to consider all of your choices and compare all of your options, working with a licensed health insurance agent may be a positive experience for you. Licensed agents can help you rule out options that don’t fit your needs and can help you maneuver what can often be a long and drawn out process.

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