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What are Navigators?

Apr 29, 2013 5:00:00 AM

The Obama administration recently released a proposed rule outlining the standards for "navigators” who will help consumers shop for health insurance in new exchanges set up by the Patient Protection and Affordable Care Act.

Navigators are organizations that will provide unbiased information to consumers about health insurance, the new health exchanges, qualified health plans, and public programs including Medicaid and the Children’s Health Insurance Program.

“Navigators will be an important resource for consumers who want to learn about and apply for coverage in the new marketplace,” Centers for Medicare & Medicaid Services Acting Administrator Marilyn Tavenner said in a statement.

For those who are not familiar with health insurance, have limited English literacy, or living with disabilities, the administration says navigators will serve an “important role in ensuring people understand the health coverage options available to them.” Navigators will provide accurate and impartial assistance to consumers shopping for coverage plans in the new marketplace.

In regulations released by the Department of Health and Human Services, navigators cannot select a plan for their clients and are not in charge of determining whether customers are eligible for federal subsidies.

They do, however, play an “important role in facilitating a consumer’s enrollment by providing fair, impartial, and accurate information that assists consumers with submitting the eligibility application, clarifying the distinctions among qualified health plans, and helping qualified individuals make informed decisions during the health plan selection process.”

In its 63-page rule, HHS says “holding an agent or broker license is neither necessary, nor by itself sufficient, to perform the duties of a navigator, as these licenses generally do not address areas in which navigators need expertise, including the public coverage options that would be available to some consumers.”

Navigators also may not be paid by insurance companies.

In addition to navigators, consumers will have access to assistance through services such as a call center, where customer service representatives can provide referrals to the appropriate state or federal agencies, or other forms of assistance programs including in-person assistance personnel, certified application counselors, agents, and brokers.

Open enrollment in exchanges begins Oct. 1, 2013 with coverage beginning Jan. 1, 2014.

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Gibson is a team of risk management and employee benefits professionals with a passion for helping leaders look beyond what others see and get to the proactive side of insurance. As an employee-owned company, Gibson is driven by close relationships with their clients, employees, and the communities they serve. The first Gibson office opened in 1933 in Northern Indiana, and as the company’s reach grew, so did their team. Today, Gibson serves clients across the country from offices in Arizona, Illinois, Indiana, Michigan, and Utah.