Can I use a broker to sign up for Obamacare, and does it cost extra?
Using a licensed agent costs you nothing. How agents are paid, what one should do for you, and what one cannot do.
- You can sign up for a Marketplace plan with a licensed agent at no extra cost. The premium is the same whether you enroll on HealthCare.gov yourself, by phone, or with an agent.
- The commission an agent earns, the amount the insurance company pays for handling the sale, is not the same at every company. Expect an agent to explain why a specific plan fits your doctors, your medicines and your budget.
- If anyone promises you a subsidy amount before asking your household income and size, or says they work for the government or HealthCare.gov, walk away.
Yes, you can, and it costs you nothing extra. A Marketplace premium, the monthly bill for the coverage, is filed with regulators. The price is the same whether you enroll on HealthCare.gov yourself, over the phone, or with a licensed agent.
There is no broker fee and no markup. The same plan does not cost less if you enroll on your own.
How brokers are actually paid
After you enroll, the insurance company pays the agent a commission, an amount the company pays for handling the sale. It is built into the premium whether or not you use an agent, which is why turning one down saves you nothing.
The commission is not the same at every company. That is why you should expect an agent to explain why a specific plan fits your doctors, your medicines and your budget. If the reasoning is thin, ask harder questions.
What a broker should do for you
- Compare the plans sold at your address across carriers, not just one company.
- Check your own doctors against each plan's network, the list of doctors and hospitals the plan has a contract with.
- Price your own prescriptions on each plan's formulary, the list of drugs the plan covers.
- Work out whether you qualify for cost sharing reductions, discounts that lower what you pay at the doctor, and point you to a Silver plan if you do.
- Fill out the application with you, including the employer coverage questions people get wrong.
- Answer the phone in March when a claim is denied.
That last one matters most. Enrolling is the easy part, and the rest of the job is what happens when a claim is denied and you need someone to call.
What a broker cannot do
- Change your premium. It is filed and fixed.
- Change your subsidy, the tax credit that lowers your monthly bill. That comes from your household income and household size.
- Get you coverage outside an enrollment window without a qualifying life event, a change in your life that opens a window to enroll.
- Promise you a dollar amount before seeing your household details.
If anyone promises you a subsidy amount before asking your household income and size, walk away. Same if they claim to work for the government or for HealthCare.gov. We are an independent agency, not a government office.
Brokers, navigators and assisters
A certified navigator or assister can help you fill out the application at no charge, but is not allowed to recommend a specific plan. A licensed agent can recommend one. Both are legitimate. They do different jobs.
What to expect from us
Bring your income estimate, your household details, your doctors and your medicine list. Plan on about half an hour. We are independent, so we compare the insurance companies available in South Texas rather than selling one.
Se habla español. See what the application involves and what to bring.
Gather those papers, then sit down with someone and go through the plans line by line. Call our McAllen office at (956) 687 3334, or enter your ZIP code in the form on this page.
Common follow-up questions
Is it cheaper to enroll myself?
No. The premium is the same whether you use HealthCare.gov, the call center or an agent.
How is the agent paid?
The insurance company pays a commission after you enroll. That cost sits inside the premium whether or not you use an agent.
Can an agent get me a bigger subsidy?
No. Your subsidy is set by your household income and size. An agent can make sure it is figured correctly, which is a different thing.
Want this looked at properly?
We are an independent agency in McAllen serving Hidalgo, Cameron and Starr counties. There is no obligation to talk it through.
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Health and ACA
Gerino Alejos
Licensed insurance agent · License 3128710 · NPN 18243381
Owner of McAllen Insurance Group, an independent agency on North 10th Street in McAllen. Works with clients across Hidalgo, Cameron and Starr counties on Medicare, Marketplace health, life and auto coverage. Se habla español.