Purchasing a health insurance plan from the Health Insurance Marketplace can be an effective way to get affordable, comprehensive health care coverage. Yet while there are many compelling health care plans that individuals, companies, and families can select, finding the best plan can be much trickier. Moreover, even if individuals, companies, or families identify an ideal health care plan, actually enrolling in that plan can be easier said than done.
For these reasons, it is worth your time to explore the different types of actors that can help you find health care. Whichever group of individuals that you choose, they offer a helping hand as you navigate America’s health care system.
Health Insurance Assisters and Navigators
To start, let’s talk about health care assisters and navigators. We are bunching together assisters and navigators because they predominantly have the same role besides a few differences.
According to HealthCare.gov, health care assisters are “individuals or organizations that are trained and able to provide help to consumers, small businesses, and employees as they look for health care options through the Marketplace.” Assisters do this by doing things like helping their clients complete eligibility and enrollment forms. You may also see health care assisters characterized as in-person assisters. As for navigators, you will find that HealthCare.gov essentially provides the same definition. They exist to help you find health care coverage on the Health Insurance Marketplace.
Both assisters and navigators need to be unbiased and they provide their services for free. These are two substantial benefits, as both assisters and navigators will give you unbiased advice as you search for a health care plan. Assisters and navigators have some restrictions, however. Among other things, they cannot answer questions about claims or billing, speak about health care alternatives that are not on the Health Insurance Marketplace, and have certain restrictions in helping you determine whether you’re eligible for tax credits.
As for the differences between assisters and navigators, there are several. For one thing, navigators must be partnered with community-based organizations (like unions, nonprofits, chambers of commerce, and trade associations). Along with this, assisters and navigators are paid in different ways. Assisters are paid for every successful application ($58) and successful annual renewal ($25) while navigators are paid based on meeting state enrollment targets. In other words, while the incentive structures are similar, they can be slightly different.
Assisters are a great fit for people in simple scenarios, who have good health and straight forward income statements. Because assisters cannot advise you on income and tax strategies, due to the limitations of their licenses, for more complex issues defer to a health broker.
Health Brokers
Health brokers can also help when you, your family, or your business are searching for health care. Looking at HealthCare.gov’s definition, you can see that brokers are people or businesses that can help you pay for and find health care coverage.
Like assisters and navigators, brokers can help you find a so-called Qualified Health Plan on the Health Insurance Marketplace and Medicaid and CHIP plans. That being said, brokers aren’t limited to these specific health care plans. Instead, they can recommend health care plans that are on the private market, along with SHOP health care coverage for small businesses.
Health care brokers also don’t have some of the restrictions that assisters and navigators have. For instance, brokers can provide more in-depth assistance when their clients are completing applications. Clients can rely on brokers’ experience and knowledge of the health care market to find plans that better meet their objectives and goals. Brokers can even be helpful resources if clients have questions about billing or pending claims.
Finally, health care brokers have a different compensation structure compared to assisters and navigators. They typically get payments from insurance companies after you (and other clients) enroll in specific health care plans. Because of this, health care brokers aren’t completely unbiased the way that assisters and navigators are unbiased, especially if they only represent plans and companies who pay them to recommend a particular product.
Making Your Choice
As you can see, navigators, assisters, and brokers can help demystify many of the parts of finding a great health care plan. But on the other hand, there are key differences between all three of these actors.
Because of this, it is helpful to review their pros and cons. From there, evaluate your own wants and needs when searching for a health care policy. By finding a specific group that matches up with those wants and needs, you will be able to efficiently find your next health care plan.
About PA Health Advocates
As you can see, there are several moving parts when considering an Assister or Health Broker. PA Health Advocates has decided the Health Broker model gives them the most flexibility to provide solutions that directly solve the problems of our constituents. Whether on-exchange, off-exchange, Medicaid, or CHIP, not being confined gives us a broad group of tools to address our client's needs. To reduce conflicts of interest we are transparent(just ask) and our product shelf is exhaustive. Each year we get annual certifications at the state and federal levels. In regular talks you will get options from, including but not limited to:
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