The first thing many people will tell you about health insurance is that it’s complicated. Between public and private plans, HMOs, PPOs, and high deductibles, it can be hard to know which plan is right for you.
About half (51%) of insured adults report some difficulty understanding at least one aspect of their health insurance, including what insurance covers, out-of-pocket costs, and benefit explanations, according to health policy research organization KFF’s 2023 survey of 3,605 US adults.
That’s where brokers come in. Brokers explain health insurance plans to consumers and help them decide which plans work best for them. Patients may have questions about monthly payments, out-of-pocket costs, and in-network providers, for example.
“Healthcare is not a one-size-fits-all [thing], so you want to make sure you’re picking the right plan for you based on your personal needs,” Jennifer Chumbley Hogue, owner of KG Health Insurance, told Healthcare Brew.
But brokers have become a hot topic in healthcare lately, particularly due to lawsuits over alleged kickbacks. The Department of Justice is currently suing large Medicare providers, accusing them of paying millions to brokers in exchange for directing patients toward plans that would give insurers the most money.
In March, US Reps. Kathy Castor and Deborah Ross of Florida and North Carolina, respectively, introduced a bill called the Insurance Fraud Accountability Act to prevent broker schemes. The law would criminally penalize and boost consumer protections against brokers who change clients’ health plans without their knowledge or agreement.
We spoke with experts to discuss what exactly brokers do and what changes they’ve seen in recent years.
What’s the difference between a sales agent and a broker?
Though commonly confused, sales agents and brokers have different employment models, though both are required to have a license to operate in their state.
Brokers work with different plans to find potential enrollees in their area and share several options based on the patients’ needs.
Sales agents, however, are employed by one health plan, either public or private, and look to sell that plan to patients. Both jobs often work on commission, though payment models vary based on where the employee works.
“Brokers are on the frontline dealing with the public, explaining to them how it works—hopefully in a very generic, easy way to understand. Our seniors, especially, are overwhelmed with the amount of paper they receive each month on plans and options,” Chumbley Hogue said.
In a 2024 University of Michigan poll of 3,300 older adults, 52% were concerned about the cost of health insurance and Medicare, and 53% were concerned about financial scams and fraud.
How has the job changed in the last 20 years?
Brokers have seen changes in policies over the past 15 years from various presidential administrations, and these have changed how they approach their jobs.
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For one, the implementation of the Affordable Care Act (ACA), which former President Barack Obama signed into law on May 23, 2010, and the creation of the ACA marketplace, which opened on Oct. 1, 2013, created “massive upheaval nationwide,” Chumbley Hogue said.
“The only ones who really understood it were the brokers having to deal with it every single day,” she said.
The ACA is complicated and continuously changing, so it initially took time for brokers to learn and understand it. Meanwhile, public perception of the law has improved (from favorable with 46% of US residents in 2010 to 64% in 2025) and membership has risen (11.7 million to 24.3 million enrollees between 2015 and 2025), according to KFF.
The introduction of Medicare Part D in 2006, which implemented coverage of outpatient medications, was another major shift. This was compounded by additional changes codified in the 2022 Inflation Reduction Act that added an out-of-pocket spending cap and drug discounts for patients on Medicaid.
Former President Joe Biden also limited broker access to healthcare.gov to prevent plan changes without patient consent. Under the Biden administration, the Centers for Medicare and Medicaid Services (CMS) also finalized new rules in January to penalize brokers who changed plans without patients’ knowledge.
What are the current challenges in the broker field?
Brokers struggle to close health equity gaps, Mikh Yusupov, founder and president of field marketing organization Affordable Care Agents, told us, as it can be hard to connect people from underserved communities to plans that work for them.
It’s particularly hard for immigrants, he added. A 2023 study from KFF found that about half of undocumented and 18% of legally residing immigrant adults are uninsured compared to 1 in 10 US citizens.
“There are immigration eligibility issues that we have to deal with on a day-to-day basis,” Yusupov said. “When you’re working with underserved communities, it requires not just a regular broker. It requires a broker that’s well trained [and] understands cultural competencies.”
The other main challenge, he said, is the system itself, which is “not easy to navigate.” It’s hard for people to work through health plans by themselves, he added, meaning a lot of the job is helping people with paperwork.
“Every time brokers are not accountable for what they do, or anytime you have agencies that are not doing what they’re supposed to, people like us suffer. CMS comes out with more regulation, the state comes out with more regulation, then it makes our job harder and harder,” Yusupov said.