Two months into the first open enrollment season of the new individual health insurance market, the government-run NY State of Health (NYSOH) online health insurance marketplace continues to diminish the role of the licensed insurance broker (or “producer”). Considering part of health insurance premiums includes a built-in broker commission, it is quite disturbing that the NYSOH website is not advising individual medical insurance shoppers that they are already paying for broker assistance, nor does it inform individuals that they should be seeking help from licensed insurance professionals to help them decide on a new plan for their families.

Everyone Enrolled In Coverage Pays a Broker Commission

With health insurance, a portion of your premium is being allocated for a broker commission. For example in the NYC metro area, the price for a single rate Platinum medical plan with Health Republic Insurance Company of NY is $516 per month. The embedded broker commission of this policy is 2% (or $10.32 per month). Thus, if you secure this health plan without broker assistance, the carrier keeps the commission. Practically every private health insurance carrier has a broker commission built into the monthly policy premium, whether a broker assists you or not.

Unlicensed Navigators Are “Experts”?

Insurance brokers are licensed individuals in the state of New York, and are heavily regulated by the NYS Department of Financial Services. This is why only insurance brokers can make plan recommendations to individuals shopping for health insurance, and why their commissions are built into policy premiums. Yet, the NYSOH does not inform individuals about the existence of these insurance knowledge champions, who can assist consumers in picking a plan, and which consumers are going to be paying for their services anyway. Instead, they advise consumers to contact “Navigators”.

Below is the exact language taken directly from the NYSOH website home page:


Navigators are the experts who will help New Yorkers (individuals): Apply for health insurance coverage, understand their coverage options, and enroll in a plan that is right for them.”

“Navigators” are persons hired by the state (paid for with grant money) whose role is to assist people with enrolling in health insurance via the NYSOH website only. They are not licensed insurance producers, nor do they get paid commissions on health insurance policies. Because they are not licensed, they are not allowed to make plan recommendations to consumers, nor are they subject to criminal background checks, nor can they be appointed by health insurance carriers to write policies outside of the NYSOH Marketplace, which licensed producers are. Yet, these are the “experts” who will help NY residents apply, understand, and enroll in health coverage?

It should also be pointed out that NYSOH Call Center representatives are also not licensed to write insurance. They are merely state employees that are tasked only with helping individuals enroll in health coverage with tax payer subsidy assistance via the NYSOH Marketplace website.

Then What’s The Point Of The NYSOH Exchange Website?

First, it’s important to understand that individual health insurance can be obtained either through the NYSOH website (“on-exchange”), or directly with an insurance carrier with licensed broker assistance (“off-exchange”). NYSOH is merely a government-run enrollment facilitator for those who need help paying their premiums with tax payer dollars. Thus, the only reasons why someone must purchase health insurance on-exchange are:

-The applicant needs help with paying their premiums via Advance Premium Tax Credits (or a “subsidy”)
-The health plan that the applicant wants is only available on-exchange (very rare, as most carriers offer the same plans on or off-exchange)

About the only other reason why someone would need to speak to someone at the NYSOH, is if they were denied a tax payer subsidy when they shouldn’t have been. In these cases, applicants would need to appeal their subsidy eligibility determination with a NYSOH Call Center representative.

Know Your Individual Health Coverage Enrollment Methods

Licensed brokers can provide NY individuals with much more information than a NYSOH Navigator or Call Center representative can, and without even needing to visit the NYSOH website. Thus, when shopping for individual health insurance coverage for you and your family, speak with a broker who can:

-determine if you are eligible for a premium subsidy
-provide you with prices, benefit summaries, and prescription drug lists with health plans that are available on or off-exchange, who can then recommend coverage options for you based on your unique situation
-assist you with looking up doctors/hospitals that are in network with the health plan you are considering purchasing. *Note* Always call your providers directly to double-confirm health plan participation

If your broker determines you are not eligible for a subsidy (using tools provided by the NYS Department of Health), he can enroll you in a health plan on-exchange (bypassing the income portion of the NYSOH website application), or with a simplified paper application (avoiding the NYSOH website entirely). If he determines you are eligible for a subsidy, he can enroll for you on the NYSOH website requesting financial assistance.

What About Dental & Vision Coverage?

The majority of the individual health plans in NY are not including pediatric dental coverage. Licensed brokers can also assist you with enrolling in fully ACA-compliant dental & vision plans off-exchange for your dependent children, and for you and your spouse as well. Plus, because your broker will be enrolling you in an ACA-compliant dental plan, you will not be subject to the individual mandate tax penalty for not having a qualified health and dental/vision plan for your dependent minor children.

Why Would The NYSOH Not Promote Brokers?

That’s a very good question, and one can only speculate why the NYS government is reluctant to share this information. Could it be that the insurance company executives are in bed with the politicians? Possibly. Could it be that the state needs to justify the tax money (a lot of it) being spent on hiring NYSOH call center reps, and navigators? You bet it’s possible. We’ll leave that for you to decide. 🙂

The bottom line is, if you are going to be paying (like it or not) for broker assistance in the form of embedded commissions in policy premium payments, why not contact the true experts to assist you? For more information on obtaining the best possible health insurance policy for you and your family, contact a licensed insurance professional.