The difference between Health Insurance Agents, Brokers, and Navigators

health insurance agents Jacksonville, FL

Finding the right health insurance coverage can be challenging. For people who use healthcare.gov or other government-administered health network sites to purchase their own insurance under the Affordable Care Act, the array of health insurance agents, brokers, and insurance navigators can get confusing.

We’re breaking down the differences between these three roles to help you find the right fit for your needs.

Understanding the Differences Between Exchange Navigators and Licensed Health Insurance Agents

Exchange navigators and licensed health insurance agents can both help you understand the plans available from the government, although licensed health insurance navigators have a more robust area of expertise. 

The Role of the Exchange Navigator

Navigators offer unbiased education about the exchange health plans which can include helping individuals determine if they’re able to qualify for Medicaid or other subsidies and walking applicants through the enrollment process. Other duties can include helping policyholders with post-enrollment coverage issues and filing eligibility appeals (although these are not representatives, just an advisor to help with the filing process).

Exchange navigators also help consumers file for shared-responsibility exemptions when applicable and provide information about tax credits for enrollment. They also help explain the basic concepts of an individual’s health care plan and offer assistance to those who otherwise would be underrepresented.

The unbiased opinion of a navigator means that they can’t offer advice to select one plan over another, simply provide general information for users to find the right fit themselves and answer questions about each type of policy. These professionals are employed by the state or federal government, not health insurance companies.

The Role of the Licensed Health Insurance Agent or Broker

Think of a licensed health insurance agent as your personal assistant to find the right plan for your needs and budget. These individuals must pass a comprehensive exam to receive their license, and bring a wealth of experience and knowledge to you. Agents can explain both the exchange plans and private health insurance plans, and compare the differences between them. They offer the same professional explanations of all the details of insurance plans, but unlike exchange agents, can and will make recommendations for your unique needs.

Once you’ve purchased a plan through your insurance agent or brokerage, you’ll receive ongoing representation and support.  Your insurance agent helps with questions and coverage after the fact and can help with billing, medical claims, and appeals.

Both brokers and agents are licensed by the state department of insurance and certified by the government exchange, ensuring that they’re able to give the specialized training and service clients require. In addition, brokers and agents must attend ongoing training and certification classes, addressing changes in the health insurance agency and government regulations. 

Choose the Right Health Insurance Agent

When you’re shopping for health insurance in Jacksonville, FL, be sure to choose the right agent for your company or personal needs. The team at Thomas and Associates has the knowledge, training, and practical experience, stretching back to 1970, to help guide you to the right plan for your needs, or the right structured insurance coverage for your business. Give us a call or visit us online today to see the difference our personalized service makes.


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