What a broker actually does
A health insurance broker is a licensed professional who helps you choose and enroll in a plan. They are appointed by insurance companies to sell those companies' plans, and they are paid a commission by the insurer.
Broker, agent, navigator — the differences that matter
| What they are | Paid by | Can recommend a specific plan? | |
|---|---|---|---|
| Independent broker or agent | Licensed, appointed by several insurers | Commission from the insurer | Yes |
| Captive agent | Licensed, works for one insurer | That insurer | Only that insurer's plans |
| Navigator or assister | Government-funded, trained but not licensed to sell | Federal or state grant | No — they must stay neutral |
That last row surprises people. Navigators are genuinely free and genuinely useful for paperwork and eligibility, but they are prohibited from telling you which plan to pick. If your question is "which of these should I choose," a navigator cannot answer it and a broker can.
When a broker is worth it — and when it isn't
Worth it
- You need specific doctors or hospitals in network, and need someone to actually verify it rather than trust a directory.
- You take prescriptions and need them checked against each plan's formulary. Formularies differ between plans from the same insurer.
- Your income is variable, self-employed or mid-year-changed, so the subsidy calculation is not obvious.
- You are not sure whether you even qualify for a Special Enrollment Period.
- You are weighing COBRA against a marketplace plan and need the deductible carry-forward factored in.
Probably not needed
- Your income clearly qualifies you for Medicaid — apply directly, any day of the year, no premium.
- You are simply renewing the same plan you had, with no change in circumstances.
What to have ready before you call
- Your ZIP code. Plans and prices are set by county — this is the first thing anyone will ask.
- Everyone who needs coverage, with dates of birth.
- Your best estimate of household income for the whole calendar year, not your old salary. Include severance and unemployment.
- Your prescriptions, by name and dose.
- Doctors you want to keep.
- Your COBRA election notice if you have one — it states your actual premium and your deadline.
Ten minutes gathering these turns a vague call into a specific one.
Common questions
Does using a health insurance broker cost more?
No. Individual health plan premiums are filed with your state and a broker cannot charge you above or below the filed rate. The commission is built into the premium whether you use a broker or buy direct. Buying direct saves nothing — it just means you do it alone.
What is the difference between a broker and an agent?
In everyday use they are near-interchangeable. Technically an agent represents insurers and a broker represents you, but both are state-licensed and both are usually paid by the insurer. What matters more is whether they are independent — appointed with several insurers — or captive to one.
Is a navigator the same as a broker?
No, and the difference matters. Navigators are government-funded, free, and genuinely helpful with eligibility and paperwork — but they are prohibited from recommending a specific plan. If your question is which plan to choose, only a licensed agent or broker can answer it.
Can a broker help me with COBRA?
They cannot enroll you in COBRA — that goes through your former employer's plan administrator. But they can price the alternatives against your COBRA premium and tell you which deadlines apply, which is usually the actual question.
How do I know a broker is licensed?
Ask for their National Producer Number and check it through the National Insurance Producer Registry, or use your state insurance department's licensee lookup. Both are free and take about a minute.
Will a broker try to sell me something I don't need?
A good one won't, and there are questions that reveal it quickly: ask whether they are appointed with every insurer in your county, and whether any plan they are showing pays them more than the others. Hesitation on either is a signal.
Do I need a broker in my own town?
No. Individual plans are sold and priced by county, and everything a broker checks — networks, formularies, subsidy eligibility — is done by computer. A licensed agent anywhere in your state can help you as well as one down the road.
Is there a health insurance broker near me?
You do not need a local one, and looking for one narrows your options for no benefit. Calling (866) 821-1808 connects you with a licensed agency that can quote the plans available in your specific county.
Talk it through with a licensed agent
Which option is right depends on your state, your income and which doctors you need to keep. A licensed agent can walk through it with you in about eight minutes.
Free to call, no obligation, and we never ask you for payment. CobraScout is paid by the agency that answers, not by you. TTY 711.
Sources
- HealthCare.gov, How to pick a health insurance plan
- 45 CFR § 155.220 (agents and brokers in the Marketplace)
- National Association of Insurance Commissioners, producer licensing