ACA Navigators – Who, What and How?

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September 19th, 2013

ACA NavigatorsWhen the ACA health exchanges open this October, many people in the US will be left not knowing where to go or who to speak to for assistance in choosing the best coverage available. For this reason, funding has been awarded to over 100 organizations and groups that will act as “Navigators” within the marketplace. However, their role in the process of attaining health insurance coverage remains unclear. Below, we take a look at the navigator’s role, who they are, what they do, and how they do it.

Who

105 organizations nationwide, including community groups, healthcare providers, business groups, advocacy groups and social service organizations, will share a $67 million federal grant to act as navigators in the ACA health exchanges.

What

Navigators will ultimately be responsible for guiding individuals through the process of purchasing insurance coverage on the exchanges. They will help with the registration process, assist with the understanding of each available plan, and advise on choosing the best available plan.

HHS Secretary Kathleen Sebelius cited the Navigators as one of many resources available to consumers, saying, “Navigators will be among the many resources available to help consumers understand their coverage options in the marketplace.” She went on to describe the navigator system as “a network of volunteers on the ground in every state – healthcare providers, business leaders, faith leaders, community groups, advocates and local elected officials.”

While the navigator groups will be available to help everyone, the federal government hopes that they will encourage those who do not currently have health insurance to purchase it and be most beneficial to those that cannot afford more expensive plans. However, the ACA forbids navigators to recommend specific plans or coverage and they cannot receive compensation from insurers or providers.

How

Once the exchanges open, each state must organize its own approved network of navigators with each group completing state and federal training prior to being approved.

After the navigator network has been approved, individuals looking to purchase insurance on the exchange must provide the following information to receive assistance:

  • The number of dependents requiring coverage.
  • Family income information.
  • Other sources of available coverage, such as employee benefits.

Despite being a federally funded organization, the navigator system has come under scrutiny from many who have opposed the ACA. Many states have added additional regulations to the legislation in order to ensure navigators will not disclose personal information or receive funds from external sources to guide buyers towards purchasing certain types of coverage. However, administration officials have been quick to point out that that ACA clearly outlines the process of using an individual’s data and how it will be protected in Section 4302.

While the navigator network may help the consumers shop for coverage, many insurers, brokers, and providers are worried about the effect it may have on their revenues, profits and market presence.


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