The best questions to ask a health insurance broker cover six things: whether they are licensed, how they get paid, which carriers they can actually offer, whether your doctors and prescriptions fit the plans they show you, what you will really pay in a year, and who helps you after you enroll. Get clear, written answers to those and you will know whether this is the right person to trust with your coverage.
I’m a licensed independent health insurance broker, and I would rather you walk into our first conversation with a list than with a vague worry. Insurance language is confusing on purpose, or at least it feels that way. A good broker welcomes hard questions. Here is the list I would use if I were on your side of the desk.
TL;DR
- Confirm the broker is licensed in your state, and ask how they are paid and by whom.
- Ask which carriers and plan types they can offer, and which ones they cannot.
- Bring your doctors, hospitals and prescriptions, and have the broker check each one against every plan.
- Compare premium, deductible, copays, coinsurance and out-of-pocket maximum side by side, and get the Summary of Benefits and Coverage (SBC) in writing.
- Ask who you call after enrollment for claims, billing and coverage problems.
Table of Contents
- Before the call: know what you need
- Questions about the broker: license, pay and independence
- Questions about the plans they can offer
- Questions about your doctors, hospitals and prescriptions
- Questions about what you will really pay
- Questions about paperwork and promises
- Questions about help after you enroll
- Broker or navigator: which one do you need?
- Talk to a Sobal broker
- A one-page checklist to bring with you
- FAQ
- Sources
Before the call: know what you need
A broker can only match you to a plan if you can describe what you want from it. Spend ten minutes on this before any call, because it changes the quality of every answer you get.
Write down:
- Who needs coverage. You alone, a spouse, kids, employees?
- Your doctors and hospitals. Names, not specialties. Include the specialist you see twice a year.
- Your prescriptions. Drug name, dose and the pharmacy you use.
- Your expected use. A routine year with a checkup and a few prescriptions looks different from a year with a planned surgery or a pregnancy.
- Your budget, in two parts. What you can pay each month, and what you could pay in one bad month if you got hurt.
That last point matters. State insurance regulators advise shoppers to think about network needs, prescription coverage, expected use and both premium and out-of-pocket budget before choosing. A broker who hears all of that can narrow dozens of plans to a short list.
Questions about the broker: license, pay and independence
You are trusting this person with a decision that affects your finances and your health. These questions are fair, and they should get easy answers.
Are you licensed in my state?
Insurance is regulated state by state. Your state insurance department can confirm that an agent or broker is licensed in your state. Ask for the broker’s full name and license number, then look them up on your department’s site. It takes two minutes.
If you live in one of the states we serve, a Sobal broker will happily give you that information. We work in 31 states, so it is also worth asking whether the broker is licensed where you live and not just where they are based.
How do you get paid?
This is the question people feel rude asking, and it is the one I most want you to ask. Agents and brokers are generally paid by the insurance companies whose plans they sell when you enroll. That means you usually do not pay the broker for the advice itself.
Follow up with two more questions:
- Do you charge any fee on top of the carrier’s commission? If so, how much, and when?
- Is the commission the same on every plan you show me?
On the business side, we publish a broker fee line on our business health insurance page, so ask any broker, including us, to put fees in writing before you commit.
Do you represent more than one insurance company?
Independent brokers generally work with multiple carriers, which gives them a reason to match you with a plan you will keep. A broker tied to one company can only show you that company’s plans. Neither is wrong, but you should know which one you are talking to.
If you are not sure how the titles differ, our guide on broker vs. agent walks through it, and our overview of what a private health insurance broker does shows what a good first conversation looks like.
Who is my person after I enroll?
Ask for a name, a direct phone number or email, and the languages the broker works in. At Sobal you get direct access to your broker in English or Spanish, and our Spanish-language health insurance page has a checklist you can use in either language.
Questions about the plans they can offer
A broker’s advice is only as wide as their menu. These questions show you how wide that menu is.
Which carriers and plan types can you offer me?
Expect to hear about some mix of these:
- ACA Marketplace plans
- Private, medically underwritten plans
- Group plans for small businesses
- Dental, vision, accident, critical illness, disability and life coverage
Then ask the mirror question: what can’t you offer me? Maybe a certain carrier isn’t available through them, or a certain plan type isn’t sold in your county. An honest broker says so, and it lets you decide whether to look elsewhere for that piece.
Is this plan ACA-compliant, and what does that mean for me?
The first thing to settle is whether a plan is ACA-compliant and covers the essential benefits without pre-existing condition exclusions. The Delaware Department of Insurance guide tells consumers to check this and to ask what a plan does not cover.
Some plans are not ACA Marketplace plans. For example, private medically underwritten plans ask about your health history when you apply. That can mean different pricing, and it can mean different rules about pre-existing conditions. It is not a problem to be afraid of. It is a design difference you should understand, and a broker should explain it plainly. Our guides on how medically underwritten insurance works and which plan types still underwrite go deeper.
Good questions here:
- Does this plan ask about my medical history? What happens if I leave something out or forget it?
- Is it a PPO, an HMO or something else, and can I see any doctor or hospital?
- Does it cover the essential benefits, such as prescriptions and maternity care? Where does it stop?
- Is it portable if I move or travel out of state?
- Can the carrier change the price or terms at renewal?
If you want to see how plan types compare, we break down indemnity vs. PPO and POS vs. PPO using the SBC.
Do you also sell supplemental coverage, and how does it fit with my main plan?
Supplemental products such as dental, vision, accident and critical illness are meant to sit beside a main medical plan. Ask the broker to show you what each one pays, when it pays, and what gap it fills for you. Dental waiting periods are a good example: some plans make you wait months for major work, and no-waiting-period dental plans exist if that matters to you.
Questions about your doctors, hospitals and prescriptions
This is where plans win or lose for most people. A cheap premium means little if your cardiologist is out of network.
Ask the broker:
- Is each of my doctors and hospitals in this plan’s network? Please check by name.
- Are my pharmacies in network?
- Is each of my medications covered, and what tier is it on?
- What happens if I need to see someone out of network?
The state insurance guide is direct on this point: ask whether your doctors and hospitals are in the plan’s network and check whether your pharmacies are in network too. Do not take “most doctors are in network” for an answer. Ask the broker to confirm yours, and then look at the carrier’s directory yourself before the plan starts. Directories change.
If you also use services outside the usual doctor visit, such as talk therapy or complementary care, ask about those too. Our partners in the wellness world have written about hypnotherapy insurance coverage, which is a good example of how coverage for a specific service depends on the plan and the provider.
Questions about what you will really pay
The premium gets you in the door. It is what you pay each month to keep the plan active. Once you walk in, other costs decide what a year actually costs.
Here is how the pieces work together:
| Term | What it means | The question to ask |
|---|---|---|
| Premium | Your monthly payment to keep coverage active | What is the total monthly price for everyone covered? |
| Deductible | What you pay before the plan starts sharing costs | Does it apply to all services, or are some covered before it? |
| Copay | A flat fee for a visit or prescription | What are the copays for primary care, specialists, urgent care and generic drugs? |
| Coinsurance | Your percentage of a bill after the deductible | What is the percentage, and for which services? |
| Out-of-pocket maximum | The most you pay in a year for covered care | What counts toward it, and is there a separate one for out-of-network care? |
The out-of-pocket maximum is your financial safety net. It is the number to compare when you are worried about a worst-case year. The Delaware guide tells shoppers to compare premiums, deductibles, copayments, coinsurance and out-of-pocket maximums across plans, not just the monthly price.
Two practical asks:
- Ask the broker to run a sample year. One routine year, and one year with a hospital stay. Add up premiums plus what you would pay in each plan.
- Ask what else to budget for. Some costs sit outside the plan, such as imaging or care from out-of-network providers. For a sense of how a single service can be priced with and without insurance, see this look at what a DEXA scan costs.
If the coinsurance part feels abstract, our article on coinsurance vs. copay shows how 20% can turn into real money on a large bill.
Questions about paperwork and promises
A conversation is not a contract. Before you enroll, get things on paper.
Can I see the Summary of Benefits and Coverage?
The SBC is a standardized summary that lets you compare plans on the same terms. Request it, along with the full plan details in writing, before you enroll. The state guide recommends getting the SBC and plan details in writing so you can check what the plan covers and what it does not. Having documents in a standard format makes this easier, and it’s a habit worth building. A broker who is confident in the plans they recommend will send them without hesitation.
What are the exclusions and limits?
Ask for the list of what the plan does not cover, any annual or lifetime limits on specific services, and any waiting periods. Ask the broker to point to the page in the documents, not just to say it from memory.
What is the application process, and what happens if something goes wrong?
For plans that ask health questions, answer them completely and accurately. Ask the broker how the carrier handles an application, how long a decision takes, and when coverage begins. Get the effective date in writing.
Questions about help after you enroll
The sale is the start of the relationship. Many people only discover how much a broker is worth when something goes wrong.
Ask:
- Who helps me if a claim is denied or a bill looks wrong?
- Will you help me find an in-network doctor or a specialist after I enroll?
- Do you check in before renewal, when prices and plan details can change?
- If my life changes (a new baby, a job change, a move), will you help me review my options?
- How quickly do you respond, and by what channel?
At Sobal, we offer enrollment support, policy review and educational resources, so you aren’t left to figure out a document on your own. Whoever you choose, get the answer to “who do I call?” before you pay your first premium.
Broker or navigator: which one do you need?
You have two main sources of help, and they are different in how they are paid and what they can sell.
| Broker or agent | Navigator or assister | |
|---|---|---|
| Trained by | Licensed in the state where they sell | Trained and certified by the Marketplace |
| Paid by | Generally the insurance company, when you enroll | Funded to help for free |
| Can help with | Marketplace plans and often private plans too, depending on carriers they represent | Marketplace and Medicaid or CHIP applications |
| Might not offer | Plans from companies they do not represent | Plans outside the Marketplace |
The federal Marketplace explains that navigators, assisters and certified application counselors provide free help, while agents and brokers are certified to sell health plans in their licensed state and are generally paid by insurers. Its find help page adds that agents and brokers can answer questions about the plans they sell, and that some may not sell plans from companies they do not represent. In many states, brokers are also required to act in your best interest.
In my experience, the right choice depends on the plan you want. If you are only applying for a Marketplace plan and want free, neutral help with the application, an assister is a solid place to start. If you want advice across Marketplace and private options, with one person who stays with you through renewal, a broker is the better fit. Plenty of people use both.
Our perspective
We built Sobal around one belief: you should understand your health plan before you pay for it. Too many people come to us after a year on a plan with a premium that stung and a deductible they never really understood.
A lot of the self-employed professionals, freelancers and 1099 contractors we talk to earn too much for Marketplace subsidies, and they feel stuck paying full price. For many of them, private medically underwritten plans can be a real option, including PPO coverage that lets them see the doctors and hospitals they prefer. We say “can” because it depends on your health history, your state and your budget. That is exactly why we sit down with you one on one.
Our approach is education before sales. We explain how the premium, deductible, coinsurance and out-of-pocket maximum fit together, we put plan documents in your hands, and we are available in English and Spanish. Some clients have told us about savings of up to $400 per month after reviewing their options with us. Your result will depend on your own situation, and we will never promise one.
If a broker answers every question on this page clearly and without pressure, you have found a good one. We hope that’s us, and we hope you ask.
Bernie S
Talk to a Sobal broker
If you are self-employed, a freelancer, a family or a small business owner, we can walk through your doctors, prescriptions and budget with you and show you which plans fit. There is no sales pressure, and the conversation is yours to steer.
Start on our personal and family insurance page to see the plan types we work with, or visit our business page if you are insuring employees.
If you are insuring a family, our guide to family health insurance options covers the timing and the plan choices. And if you are in Florida, our Miami broker page has local detail. For the question of how to run this same conversation as a self-employed buyer, see our broker questions for self-employed buyers.
A one-page checklist to bring with you
Print this or paste it into your notes.
- Broker’s full name, license number and states licensed.
- How the broker is paid, and any fees in writing.
- Carriers and plan types offered, and what is not offered.
- Plan type for each option: PPO, HMO, POS, indemnity or other.
- Each doctor, hospital, pharmacy and drug confirmed by name.
- Premium, deductible, copays, coinsurance and out-of-pocket maximum for each option.
- A sample cost for a routine year and a bad year.
- SBC and full plan documents in hand before you enroll.
- Exclusions, waiting periods and limits located in the documents.
- Effective date, renewal process and your contact for claims help.
FAQ
How do I choose a health insurance broker?
Start by checking that the broker is licensed in your state through your state insurance department. Then ask how they are paid, which carriers they offer, and who helps you after you enroll. Pick the one who answers plainly, puts things in writing and explains the trade-offs between plans.
Does a broker cost me extra?
Brokers are generally paid by the insurance company when you enroll, so you usually do not pay a separate fee for advice. Some brokers charge fees in specific situations, such as for business services. Ask for any fee in writing before you commit.
What is the difference between a broker and a navigator?
Navigators and assisters are trained and certified by the Marketplace to give free help, mostly with Marketplace and Medicaid applications. Brokers are licensed in their state to sell plans and are generally paid by insurers. A broker can often compare Marketplace and private options in one conversation.
What should I bring to my first call?
Bring a list of your doctors, hospitals, medications and pharmacies, plus your monthly budget and the most you could pay in a single bad month. Add the ages of everyone who needs coverage. With that, a broker can narrow your options quickly.
Sources
- Smart Buyer’s Guide to Individual Health Insurance, Delaware Department of Insurance
- Get help applying for health insurance, HealthCare.gov
- Get help applying and more, HealthCare.gov
- NABIP FAQs
