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Health Insurance Agent vs Navigator: What's the Difference?



Buying health insurance can be a confusing process. You may need some help choosing the right option, getting the subsidies you are entitled to and signing up for a health plan. You may be able to get the help you need through either a health insurance agent or a navigator. Although both agents and navigators can help you sign up for a health plan, there are significant differences between the two.

What is the role of a health insurance agent?

A licensed health insurance agent can act as a personal health insurance shopper – with expertise. Agents can explain plan details and help determine if you are eligible for subsidies or Medicaid. Unlike navigators, they can also recommend a specific plan based on your circumstances. An agent can also continue to help you after you purchase a health plan with questions or issues regarding use, medical claims, billing or appeals. Health insurance agents are not only certified by the state stock exchange but also licensed by a state insurance ministry. They must receive specialized training on the products they sell from both the insurance companies they represent and government regulators.

What is the role of an Exchange Navigator?

The purpose of a health insurance navigator is to provide individuals with impartial training on exchanges and health plans. Navigators also help applicants determine if they are eligible for Medicaid or subsidies and help them sign up if they do. In addition, navigators have some optional tasks. These include:

  • Helping people file appeals (even if they can not represent an individual in an appeal)
  • Help with questions about coverage after registration
  • Provide information on premium tax deductions
  • Help with applying for shared responsibility exception
  • Educate individuals on basic concepts regarding the use of their health protection
  • Provide targeted assistance to underprivileged or vulnerable populations

What are the similarities and differences between agents and navigators?

help you use the state exchange to register with the health insurance, and it costs nothing for their services. They can also help you apply for subsidies to reduce your health insurance costs. Both have some education and are certified as guides for government exchange. Along with the similarities, there are some significant differences between agents and navigators:

  • Only a health insurance agent can recommend a plan based on your needs and budget. Navigators are not allowed to give planning recommendations.
  • Navigators have not been around as long as agents. Their role only came into being in 201
    3. For this reason, agents may have more experience than navigators.
  • Agents are licensed by state insurance departments. They carry out ongoing insurance training and pass examinations, which ensures that their knowledge of health insurance is current. Navigators can be volunteers working for non-profit organizations that only help people with insurance matters during open enrollment. They do not have the same training requirements as agents.
  • Health insurance agents are qualified and authorized to help you understand health plans that are not on a state exchange. Navigators are not.
  • If you have problems with your health insurance company, an agent can act as your lawyer. A navigator can not trade with the insurance company on your behalf.

If you are looking for a health plan, our agent can help you. There is no charge for you for our services.


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