Alyssa Lane
There are several options available for those seeking advice on medical insurance. In the US, the official source for the Health Insurance Marketplace is HealthCare.gov, where you can find free, non-biased personal help. Here, you can get assistance with your application, review your choices, and enroll. Alternatively, you can search for agents and brokers who can help you enroll through the Marketplace for a commission. For those in California, Covered California is a free service that connects Californians with brand-name health insurance. For those eligible, Medicare beneficiaries, their families, and caregivers can get unbiased help from their local State Health Insurance Assistance Program (SHIP).
| Characteristics | Values |
|---|---|
| Website | healthcare.gov |
| Website | cms.gov |
| Advice | Never share your information to anyone offering cash, gifts, or other perks |
| Advice | Share sensitive information only on official, secure websites |
| Advice | Fastest way to apply is to log in or create an account |
| Advice | Help is available in other languages |
| Advice | Apply for and enroll in a Marketplace plan through an approved partner, like an insurance company or online health insurance seller |
| Advice | You can qualify for a premium tax credit and other savings if you enroll with an agent or broker |
| Advice | To get the savings, the agent or broker must enroll you through the Marketplace |
| Advice | Use the Help On Demand service to connect with a licensed agent or broker |
| Advice | Agents and brokers may be paid a commission by health insurance plans |
| Advice | Agents and brokers can help you handle the whole process |
| Advice | Agents and brokers play an important role in educating consumers about insurance affordability programs |
| Advice | Agents and brokers help consumers compare plans |
| Advice | Agents and brokers play a critical role in helping qualified employers and employees enroll in coverage through the Small Business Health Options Program (SHOP) |
| Advice | Consumers may want to obtain professional advice from agents and brokers when applying for and selecting a qualified health plan |
| Advice | Certified application counselors (CACs) are trained and able to help consumers seeking health insurance coverage options |
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What You'll Learn
Agents and brokers
Agents
A health insurance agent is a salesperson licensed by the state and represents one or more health insurance companies. They offer insurance plans to consumers for whom they are appointed. An agent can be a captive or independent agent. A captive agent represents a single insurance carrier, while an independent agent represents multiple insurance carriers and earns a commission from the insurance companies for the products they sell. Agents are not employees of the insurance carrier but represent the applicant, not the insurance company. They can help you sign up for a health insurance plan, compare different policy types and plan levels, and enroll you in binding coverage.
Brokers
A broker usually has both a broker's license and an agent's license. They are independent insurance agents who offer multiple insurance carriers' products and are paid by commissions. They are not employees of the insurance carrier but represent their clients. They often employ insurance agents to help increase their business. Brokers typically offer other types of insurance, such as auto, home, or life insurance. They also provide services for employers looking for group insurance. A retail broker works closely with clients to find the best insurance that fits their needs.
Finding an Agent or Broker
When looking for an agent or broker, it is important to conduct comparison research in areas such as price, service, and a company's financial strength. You can locate an insurance agent or broker in your area by checking company websites or social networking sites for agent information, contacting agent associations, or using the yellow pages for local information on agents. Remember to check the license status of the agent or broker you choose. All insurance agents and brokers licensed in California, for example, must display their license number on their business cards and marketing materials.
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Certified application counsellors
CACs are knowledgeable about the different types of Marketplace plans available, including bronze, silver, gold, and platinum, each with varying premium and out-of-pocket costs. They can answer questions about the Marketplace, assist with comparing plans, and provide information about essential health benefits, such as preventative health services offered by all plans.
While CACs cannot make specific plan recommendations—as this can only be done by a licensed insurance agent or broker—they can offer valuable guidance on insurance affordability programs and help consumers apply for premium tax credits and cost-sharing reductions. They are also well-versed in the requirements for enrolling, including the necessary documentation such as names, birthdays, social security numbers, income, and immigration information.
To find a CAC, you can search for CDOs in your state or refer to resources provided by official government websites, such as HealthCare.gov, which offer information on local organisations and individuals that can assist with the application process. These resources allow you to search by your city, state, or ZIP code to find in-person assistance in your area. Additionally, some CACs may offer assistance in languages other than English, ensuring that consumers from diverse backgrounds can access the support they need to navigate the complex world of health insurance.
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Official websites
In the United States, federal government websites often end in '
Additionally, each state may have its own official websites for health insurance information. For instance, NYStateOfHealth.ny.gov is the official website for individuals, families, and small businesses in New York seeking health insurance. It offers tools to compare and select the right health insurance plan and provides information on enrollment periods.
When visiting other medical websites, it is important to exercise caution. Websites with '
Remember, when sharing sensitive information, ensure that the website is secure. Look for the 'https://' prefix and a lock symbol in the address bar to confirm that your connection is secure and your information will be transmitted safely.
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Local organisations
When it comes to seeking advice on medical insurance, there are several local organisations and resources that can provide guidance and support. These entities are well-equipped to assist individuals in understanding their options, enrolling in suitable plans, and even obtaining financial assistance. Here is some information on where to turn for guidance:
Certified Application Counselor Organisations (CDOs): CDOs are designated by the Centers for Medicare and Medicaid Services (CMS) and play a crucial role in assisting individuals seeking health insurance. These organisations comprise trained professionals known as Certified Application Counsellors (CACs), who aid consumers in exploring their insurance choices and navigating the intricacies of Federally-facilitated Marketplaces (FFMs). CDOs encompass community health centres, healthcare providers, hospitals, and social service agencies, offering a diverse range of support options.
Navigators: Navigators are entities that receive grant awards from CMS to operate in FFM states. They assist consumers in preparing applications, determining eligibility, and enrolling in coverage through Marketplaces. They also help individuals qualify for insurance affordability programs. Navigators are required to undergo comprehensive federal training and background checks, ensuring they are well-equipped to guide consumers. They also raise awareness about coverage options, helping the uninsured find affordable plans that meet their needs.
Agents and Brokers: These professionals are trained and certified to sell health plans in their licensed states. They aid consumers in understanding Marketplaces, exploring insurance affordability programs, and enrolling in suitable coverage. Agents and brokers are typically paid a commission by health insurance plans when they help individuals enrol in a specific plan. They can provide valuable insights and assistance in navigating the complexities of health insurance options.
Local Assistance Programs: By searching based on your city, state, or ZIP code, you can find a plethora of local organisations and individuals offering assistance. These entities can help with the application process, plan selection, and enrolment. Some even provide services in languages other than English, ensuring that language is not a barrier to accessing critical healthcare information.
Government Initiatives: Initiatives like Medicaid and the Children's Health Insurance Program (CHIP) offer free or low-cost health coverage to individuals and families who meet certain income criteria. These programs cater to low-income families, children, pregnant women, the elderly, and people with disabilities. State agencies play a vital role in facilitating enrolment in these programs, ensuring that those who qualify receive the necessary support.
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Insurance affordability programs
When it comes to medical insurance advice, there are a variety of places you can turn to. One option is to seek help from agents and brokers who can assist with enrolling through the Marketplace and help you understand insurance affordability programs. These professionals can guide you in comparing plans, determining eligibility, and applying for premium tax credits and cost-sharing reductions. They can be particularly helpful for employers and employees looking to enrol in coverage through the Small Business Health Options Program (SHOP).
Another resource is Healthcare.gov, which offers free and non-biased assistance with health insurance applications. You can create an account on their official website to get started. They can help you fill out applications, review your choices, and enrol in a plan. Additionally, you can search for local organisations and people near you or in your city, state, or ZIP code that can provide assistance with coverage applications. Some of these organisations may offer help in languages other than English and provide in-person assistance.
For those in the United States, the Centers for Medicare & Medicaid Services (CMS) also provide in-person assistance in Health Insurance Marketplaces. Certified Application Counsellors (CACs) are available to help consumers seeking health insurance coverage options through Federally-facilitated Marketplaces (FFMs). These counsellors are overseen by CDOs, who work with organisations such as community health centres, hospitals, or social service agencies.
Additionally, CMS has a program called Navigators, where grants are awarded to organisations serving as Navigators in FFM states. These Navigators assist consumers in preparing applications, establishing eligibility, and enrolling in coverage through the Marketplaces, helping them qualify for insurance affordability programs.
It's important to note that job-based health plans are considered "affordable" in 2025 if your share of the monthly premium for the lowest-cost plan is less than 9.02% of your household income. If the premiums are not affordable, you may qualify for savings in a Marketplace plan.
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Frequently asked questions
You can get medical insurance advice from agents and brokers, who can help you enroll through the Marketplace and handle the whole process.
You can search for agents and brokers near you or have them contact you.
Yes, you can use the Help On Demand service to connect with a licensed agent or broker. You can also apply for and enroll in a Marketplace plan through an approved enrollment partner, such as an insurance company or online health insurance seller.
Certified Application Counselors (CACs) are trained to help consumers seeking health insurance coverage options. CACs may be based in community health centers, hospitals, or social service agencies.
