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The Center for Consumer Information & Insurance Oversight

 

In-Person Assistance in the Health Insurance Marketplace

Background

Starting October 1, 2013, consumers in all states will be able to choose new affordable health insurance options through a new Health Insurance Marketplace. Some states are setting up a State-based Marketplace, other states will work with the federal government in a State Partnership Marketplace and the remaining states will have a Federally-facilitated Marketplace.

No matter what state they live in, consumers can get help as they apply for and choose new insurance options. You can help provide that assistance in a number of different ways: by becoming Navigators, in-person assistance personnel, or certified application counselors. In addition, agents and brokers can also help consumers enroll in new insurance options.

Navigators

Navigators have a vital role in helping consumers prepare electronic and paper applications to establish eligibility and enroll in coverage through the Marketplaces and potentially qualify for an insurance affordability program. They also provide outreach and education to raise awareness about the Marketplace, and refer consumers to health insurance ombudsman and consumer assistance programs when necessary. Navigators play a role in all types of Marketplaces, are funded through state and federal grant programs, and must complete comprehensive training.

On August 15, 2013, CMS awarded $67 million in Navigator Cooperative Agreements to entities to serve in the 34 Federally-facilitated and State Partnership Marketplaces.

Certified Application Counselors

The Federally-facilitated Marketplace will designate organizations to certify application counselors who perform many of the same functions as Navigators and non-Navigator assistance personnel—including educating consumers and helping them complete an application for coverage. An online application will be available at the end of July 2013 for organizations who want to become Marketplace-designated organizations that can certify application counselors.  These groups might include community health centers or other health care providers, hospitals, or social service agencies. To be notified when the online application is available, visit Marketplace.cms.gov and sign up for email notifications and updates.  A sample application is posted on this website in the meantime.

Agents and Brokers

CMS expects agents and brokers to play a key role in the new Marketplaces. To the extent permitted by states, agents and brokers will play an important role in educating consumers about Marketplaces and insurance affordability programs, and in helping consumers receive eligibility determinations, apply for premium tax credits and cost-sharing reductions, compare plans, and enroll in coverage. In particular, CMS anticipates that agents and brokers will play a critical role in helping qualified employers and employees enroll in coverage through the Small Business Health Options Programs (SHOPs). We anticipate that many consumers will want to obtain professional advice from agents and brokers when applying for and selecting a qualified health plan. Below are several important resources for agents and brokers intending to participate in Federally-facilitated Marketplaces or State Partnership Marketplaces.

Additional Resources