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Why Do I Need a Health Insurance Agent?

By Erica Block and

Erica Block

Erica Block was an Editorial Fellow. She combines her interest in healthcare policy with her penchant for creating online content.

Michael LaPick

Michael LaPick Healthcare Writer

Michael LaPick is a Healthcare/Medicare writer for HealthCare.com and its web properties.

Updated on February 3rd, 2025

Reviewed by Diane Omdahl

Diane Omdahl Expert Reviewer

Diane Omdahl has been helping people navigate the complexities of Medicare for more than three decades. She is a nationally recognized Medicare expert, a registered nurse, serial entrepreneur, and has served as a technical expert for the Centers for Medicare and Medicaid Services (the organization that runs the Medicare program). She is a frequent speaker on Medicare-related issues. She has been featured in many national publications, including the Washington Post, CBS MoneyWatch, Forbes, The Wall Street Journal Market Watch, Kiplinger, and many more. Her most recent startup, 65 Incorporated, helps people 65 and older get the clear, correct, complete, and credible information they need to make important Medicare decisions. She is also the architect behind the i65 Medicare optimization software suite. i65 enables financial advisors to help clients make smart Medicare decisions.

We want to help you make educated healthcare decisions. While this post may have links to lead generation forms, this won’t influence our writing. We adhere to strict editorial standards to provide the most accurate and unbiased information.

Choosing the right health insurance plan can be overwhelming. With so many options, coverage details, and costs to consider, navigating the process alone can be confusing.

That’s where a licensed health insurance agent comes in—providing expert guidance to ensure you find a plan that fits your needs and budget.

If you’re searching for a health insurance agent near you, working with a professional can save you time, money, and stress.

What Does a Health Insurance Agent Do?

A health insurance agent is a licensed expert who helps individuals and businesses select and enroll in health insurance plans. Some agents work exclusively with one insurer (captive agents), while others operate independently and offer policies from multiple companies (independent agents or brokers). If you’re looking for health insurance agents near you, it’s important to know whether they offer plans from multiple providers or just one.

How Can a Health Insurance Agent Help You?

A health insurance agent simplifies the process of choosing the right coverage by offering:

  • Expert Advice: Agents help you compare plans and understand different pricing structures, deductibles, and copayments.
  • Personalized Recommendations: They assess your healthcare needs, including preferred doctors, prescriptions, and budget, to find the best option.
  • Assistance With Claims & Coverage Issues: If you have trouble with billing, claims, or eligibility, an agent can advocate on your behalf.

A health insurance broker may ask you:

  • Are you buying health insurance for the first time?
  • Do you currently have health insurance coverage? Why do you want to switch plans?
  • How often do you go to your doctor? Do you see any specialists? Would you like to keep your current doctor(s)?
  • Do you currently take prescription drugs? Do you require the branded version of any medications?
  • What is your budget?
  • Are you planning to add a spouse or dependents to your plan?
  • Which pharmacies do you use?

You’re Presented with Plans to Fit Your Needs

After speaking with you to go over your needs, your health insurance broker’s next duty is to put together a portfolio of health insurance options for you. Here are the things you’ll need to consider at this step:

  • Differentiate Between Insurance Plan Types: Have the agent walk you through different insurance plan types: HMO, PPO, EPO, and POS. They will explain the pros and cons of each plan format and can tell you if certain plans require referrals, if any policies offer out-of-network coverage, etc.
  • Understand Pricing Terms: Understand key pricing terms (deductible, premium, coinsurance, copay, and so on) to learn how your coverage options differ. Work with your broker to narrow down and select the option best-suited to your healthcare needs.
  • Find the Right Health Insurance Carrier: Work with them to identify carriers offering plans that meet your needs.
  • Compare Provider Networks: If you would like to continue receiving care from a particular doctor, examine the provider networks of each plan option. Check to make sure your doctor will be considered in-network under these plans.
  • Know On- and Off-Exchange Plans: Considering the push to stop incentivizing marketplace plans, make sure your agent clarifies which of your options are ACA marketplace plans and which are off-exchange, non-ACA plans. Ask about plan options which haven’t been shown to you.

Select a Plan

During and after selecting a plan, there are a few important things to keep in mind.

  • If you’re selecting an ACA marketplace plan, will your agent help you determine whether you’re eligible for a subsidy, and if so, can he or she help you process a subsidy application?
  • Can your agent walk you through your policy’s Summary of Benefits? Make sure your key points are clarified: provider network size, premium, and co-insurance cost amounts, and whether or not you need to meet a plan deductible before your insurance begins to cover a portion of your healthcare costs, etc.
  • Ask your agent if your insurance carrier has a designated point person whom you may contact if and when you have questions about your coverage. Can this representative assist in filing claims?
  • Be sure to confirm all your drugs are covered.
  • If your plan includes access to a Flexible or Health Savings Account, ask them about the steps you need to take to establish an account and access and manage your account funds.

If you’re looking for medical insurance agents near you, an experienced professional can help you make informed decisions and avoid costly mistakes.

Do You Need a Health Insurance Agent or a Broker?

While the terms are often used interchangeably, there are key differences:

  • Health Insurance Agents: Typically work with a single insurer and offer only that company’s plans. If you’re searching for a health insurance agent near you, check whether they represent one insurer or multiple companies.
  • Health Insurance Brokers: Work independently, offering plans from various providers to give you more options.

Why Work With an Agent for Medicare?

If you’re over 65, navigating Medicare plans can be especially complex. A Medicare agent near you can explain the differences between Original Medicare, Medicare Advantage, and Medicare Supplement (Medigap) plans, ensuring you get the coverage that meets your needs. Searching for Medicare agents near you can help you find a professional who specializes in these plans.

Choosing the Right Health Insurance Agent

When looking for an agent, keep these factors in mind:

  • They work at no cost to you (they’re paid by insurers, not clients).
  • They provide clear plan comparisons and pricing explanations.
  • They ensure your plan complies with federal and state laws.

Is Using a Health Insurance Agent Worth It?

Absolutely. Whether you need coverage for yourself, your family, or your employees, a health insurance agent makes the process easier. If you’re searching for Medicare insurance agents near you, a licensed expert can help you compare plans, enroll in coverage, and answer your questions at no extra cost.

Rather than navigating the complexities of health insurance alone, working with a trusted professional ensures you find the best plan for your needs.

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