Should I Use a Broker for Obamacare Health Insurance?

Trying to navigate the Obamacare health insurance marketplace on your own can be confusing and time-consuming. You may wonder if working with an insurance broker could make the process easier.

In this comprehensive guide, we’ll explain:

• What an insurance broker is
• How brokers can assist with ACA enrollment
• Key benefits of using a broker for Obamacare
• Any potential drawbacks
• How to find and choose a broker
• What it costs to use a broker

Let’s start by understanding what role a broker plays.

What is an Insurance Broker?

An insurance broker is a licensed professional who can advise you on health insurance options and help you enroll in a plan.

Key facts about insurance brokers:

• Licensed professionals: Brokers must pass state licensing exams related to health insurance products.

• Sell plans from multiple companies: Brokers have contracts with numerous insurance carriers and can offer you choices. They are not tied to just one insurance company.

• Work on your behalf: Brokers act as your advocate. They provide guidance on the best plan options and assist you with the application and enrollment process.

• Get paid commissions: Brokers typically get paid commissions from insurance carriers when they sell policies. The commissions don’t raise your rates.

• Ongoing support: After enrollment, a broker serves as your main point of contact for any questions about your health insurance coverage.

Next, let’s look at how brokers can assist with Obamacare specifically.

How Can Brokers Help With Obamacare Enrollment?

Brokers play an important role in helping consumers enroll through the Affordable Care Act (ACA) health insurance marketplace. Here are some of the key ways they can help:

Simplify the Process

• Walk you through every step of the application
• Explain confusing terms like premium tax credits, cost-sharing reductions and deductibles
• Ensure all documentation like income verification is handled properly
• Submit the application and finalize enrollment for you

Recommend the Best Plan

• Ask questions to understand your healthcare needs and preferences
• Compare all the ACA plan options in your area side-by-side
• Suggest the optimal plans based on your situation, health profile, medications and budget
• Provide plan recommendations both on and off the marketplace

Provide Unbiased Guidance

• Brokers are not tied to any one insurance carrier
• They can offer impartial advice to help you identify the optimal plan
• A broker works only on your behalf, not the insurance company

Save You Time

• Researching plans, comparing options and enrolling takes considerable time and effort
• Brokers simplify the process from start to finish so you can focus on other priorities

Resolve Issues

• Assist with troubleshooting any technical issues that arise with the ACA application and enrollment
• Help correct any errors that may occur and provide guidance if you receive an eligibility determination you don’t agree with
• Act as your advocate in appealing any decisions by the marketplace

What Are the Benefits of Using a Broker for Obamacare?

Here are some of the top benefits of having a broker assist you with ACA health plan selection and enrollment:

1. Saves you time and hassle

Enrolling through the marketplace on your own is time-consuming. There’s an extensive application covering your household details, income, citizenship status and more. A broker will complete the application for you and ensure all required documentation is included upfront. This saves you the hassle of going back and forth if items are missing.

2. Provides expertise interpreting plans

Understanding the differences between bronze, silver, gold and platinum plans can be challenging. A broker will clearly explain how the plans compare in terms of premiums, deductibles, copays, provider networks and out-of-pocket costs. They can tell you which plan tier is likely the optimal fit based on your budget and expected healthcare needs.

3. Helps you avoid mistakes

The Obamacare application process leaves room for error. Even minor mistakes like income calculation errors could make you ineligible for subsidies. A broker double checks all your information for accuracy. They also ensure proper documentation is provided so your eligibility for tax credits is confirmed upfront.

4. Assists with resolving issues

Despite best efforts, there are times when issues crop up with ACA applications and enrollment. If you receive an incorrect eligibility determination, get enrolled in the wrong plan, or have technical issues, a broker can swiftly act on your behalf. They know how to navigate the appeals process and get mistakes corrected.

5. Provides ongoing support

After you enroll, you’ll have questions about using your insurance, checking claim status, finding in-network providers, estimating costs and more. A broker is your long-term contact available to help explain your benefits and assist with claims, billing, and other issues.

6. Answers questions about subsidies

If your household income fluctuates during the year, this could impact your eligibility for premium tax credits. A broker can explain how subsidies are calculated, what to do if your income changes, and assist with updating your application if needed.

7. Offers personalized guidance

Every person’s healthcare priorities and budget is different. A broker learns about your specific situation and preferences to recommend the optimal insurance solution. The plan that’s best for your neighbor may not suit your needs.

What Are the Potential Drawbacks of Using a Broker?

While there are many good reasons to use a broker for Obamacare, there are a couple potential drawbacks to consider:

May not be as cost effective for simple situations

If you’re single with a straightforward application and few healthcare needs, the broker may not provide enough added value to justify their fees if they charge one. But for more complex situations, their expertise is extremely beneficial.

Can’t guarantee you’ll qualify for subsidies

A broker can help you apply for premium tax credits and cost-sharing reductions. But they cannot guarantee in advance you’ll qualify. Eligibility is determined by the ACA marketplace after reviewing your full application.

May not offer the full range of options

Some brokers only sell plans from certain health insurance carriers. So they may not present you with every plan available on the Obamacare marketplace. A good broker will explain upfront what options they can provide guidance on.

Overall, the benefits outweigh the drawbacks for most people buying ACA coverage. But you’ll want to ask brokers questions about their expertise, services and any potential limitations to ensure it’s the right fit.

How Do I Find and Choose an Obamacare Broker?

Here are some tips for finding and selecting a qualified, experienced broker to assist with ACA enrollment:

1. Search the marketplace website

Every state and federal Obamacare marketplace has an online tool to find local brokers. You simply enter your zip code to see brokers near you.

2. Look for ACA experience

Not all brokers are equally versed in the Affordable Care Act marketplaces. Try to find one with extensive experience enrolling people through Healthcare.gov or your state exchange.

3. Ask about carrier appointments

You want a broker appointed with as many insurance companies as possible. This ensures they can present plans from all the major carriers in your area.

4. See if they offer on and off-exchange plans

A good broker will show you plans available through the ACA marketplace as well as individual plans you can buy directly from carriers off the exchange.

5. Verify they are licensed in your state

Brokers must hold active licenses issued by your state department of insurance in order to sell health plans in your area. You can check broker licenses on your state insurance department website.

6. Meet with 2-3 brokers before deciding

Interview a few different brokers to compare expertise, services offered and how well you communicate. You want to choose the one you feel most comfortable working with.

How Much Does it Cost to Use an ACA Broker?

The vast majority of health insurance brokers do not charge fees to individual clients. Here are two typical compensation models:

Commission-based

The broker is paid a commission by the insurance carrier when you enroll in a plan. The commission comes from the insurance company’s portion of the premium. It does not raise the rates you pay.

Fee-based

In some states, a broker may charge you a one-time enrollment fee or ongoing monthly fee for service. The fees should be disclosed upfront before you commit to anything. Fee-based arrangements are less common than commission-based pay.

It’s reasonable to ask a broker if they charge fees or work on a commission-only basis. There are excellent commission-based brokers who provide top-notch