Navigators and Consumer Assistance

Exchange Navigators

Navigators are a key piece of Obamacare health insurance, serving as the guides to the exchange in each state. Staffed by the government or the state-run organization operating the exchange, these federally funded positions were created to help consumers apply for coverage through the Marketplace.

With a name reminiscent of GPS software to plant the idea of being steered in the right direction when choosing a health plan, navigators are located in public health care centers, health departments and other locations where you can apply for the exchange.

These guides aren’t the only ones helping to educate the public about their health insurance options under the Affordable Care Act, as the law created several positions for consumer assistance.These include non-navigator assistance personnel and certified application counselors, in addition to navigators.

Each role serves a different function with the same goal: help enroll Americans in Medicaid, individual health insurance or small business coverage on the exchange.


Navigator Responsibilities

Navigators are equipped to aid in the application process for exchanges. They direct consumers as they complete paper and online applications for exchange health plans. While they may not exactly be able to help you determine whether to choose a Bronze or Silver plan, they can distinguish the differences and show you how to use the marketplace website to compare policies from different insurers.

These helpers can also lead you through the subsidy eligibility process to find out if you qualify for reduced premiums or cost sharing. If your income is low enough, a navigator can also direct you to financial assistance programs such as Medicaid and CHIP (Children’s Health Insurance Program) to provide free or low-cost coverage, and help you apply.

The promotional side of the navigator role is outreach and education in the community, making sure the area is informed of their options and that they may qualify for health insurance for the first time in history, in certain cases.

As many Americans have been confused about the health reform law, one of the essential navigator responsibilities is to clarify exchanges, expansion of Medicaid and tax credits that have been developed by the ACA. The law established that navigators must be staffed by every marketplace that is state- or federally-run, and are employed by state and federal grant programs that were controversial in the implementation process.

In order to gain the title of health insurance marketplace navigator, you must complete a comprehensive training process, according to the government. However, navigators themselves need not have much more than a 12th grade education prior to this training, as it is an entry-level job. They are not to be confused with agents and brokers, and their duty is not to choose an insurance policy for you, but to obtain personal data, work with the public, and use websites.

According to job search websites prior to open enrollment, a listing for a navigator position stated that education and/or experience must consist of High School Diploma or GED equivalent with preferably two years of professional experience working with the low-income population.


The applicant should also be highly skilled in data entry, with experience in Microsoft Office and email, and have the ability to learn new software quickly. Fairly simple, but still necessary for the law to be implemented and to create thousands of new jobs across the country during a tough economic period.


Non-Navigator Assistance Personnel

Also called in-person assistance personnel, these customer service representatives are staffed by state-based exchanges only, but basically have the same job as a navigator. In each state that established its own marketplace or partners with the federal government, non-navigator assistance personnel carry out all of the navigator duties of education, outreach and application help.

These workers are part of an optional program that states could choose to establish before the state’s marketplace is financially independent of the government, and before its navigators completed training and were knowledgeable of the exchange.

While they have the same responsibilities as a navigator, in-person assistance personnel are paid by different state-level grants or contracts than the navigator program. A thorough training process is also required of such workers.


Certified Application Counselors

This is also just about the same job as the previous two, designed to educate customers about their options on the exchange and how to apply, use the site and find out if you qualify for tax credits. Certified application counselors are hired exclusively by federally-operated exchanges run by the U.S. Department of Health and Human Services (HHS).

Various organizations can apply to become designated groups who offer exchange enrollment under their roof and hire or train existing workers as certified application counselors.


Such organizations include hospitals, community health centers, doctor’s offices or social service/public health agencies. State exchanges can also elect to find application counselors independent of an organization and certify them to carry out these duties.

Unlike navigators and assistance personnel, certified organizations and counselors will not receive federal grants through the exchange, but federal funding is sometimes provided through other grant programs or Medicaid to further consumer assistance and enrollment endeavors of an organization. For instance, targeting the low-income population in the community and heightening awareness of Medicaid expansion.


Licensed Health Insurance Agents and Brokers

Agents and brokers will not receive federal grant money, but are an essential part of consumer education as exchanges get established. Seasoned insurance experts who have been licensed with private carriers for years have more experience than Obamacare exchange workers selling health plans, and therefore are considerably more qualified to help people choose the policy that fits their needs.

While shopping for coverage, considering the coinsurance, deductible and copays of your future plan are equally important as finding an affordable premium from a reputable company. Insurance agents are not limited to private insurance sales under health reform, as they may be qualified to sell exchange plans, as well.

Agents can sign individuals, small business owners and employees up for coverage as long as they have completed a training program created by the state and federal governments, and sometimes each individual carrier participating on the exchange. Testing and certifications must be finished before any agent or broker is authorized to sell such plans.

Our team of agents at East Coast Health Insurance can help you apply for plans on your state’s exchange, as it is critical to have all types of coverage available now that access has been expanded. Call us with your exchange questions at 888 803 5917.