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The Center for Consumer Information & Insurance Oversight

 

In-Person Assistance in the Health Insurance Marketplaces

Background

Starting October 1, 2013, consumers in all states were able to access affordable health insurance options through the Health Insurance Marketplace. Some states set up a State-based Marketplace, while other states will work with the federal government in a State Partnership Marketplace and the remaining states opted for the Federally-facilitated Marketplace.

No matter what state they live in, consumers can receive help as they apply for and choose new insurance through the Marketplace.

Open Enrollment for the 2015 plan year begins November 15, 2014 and individuals will again be able to provide assistance to consumers in a number of different ways: by becoming Navigators, in-person assistance personnel, or certified application counselors. In addition, agents and brokers will still be able to help consumers enroll in health insurance through the Marketplace.

Key Resources

Navigators

Navigators play 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 programs. 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 are funded through federal grant funds and must complete comprehensive federal Navigator training, criminal background checks, and state training and registration (when applicable), prior to assisting consumers.

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. A list of 2013 Navigator grant recipients can be found here: 2013 Navigator Grant Recipients. The current grant cycle runs through August 14, 2014. Entities and individuals cannot serve as federal Navigators without receiving federal grant funding from CMS to perform Navigator duties.

On June 10, 2014, CMS published a second funding opportunity announcement (FOA) making up to $60 million in cooperative agreement funds available to Navigators in Federally-facilitated or State Partnership Marketplaces. Applications are now available for this second round of Navigator funding by visiting http://www.grants.gov/ and searching for CFDA number 93.332. The FOA provides detailed information on applicant eligibility requirements, a state listing of Federally-facilitated and State Partnership Marketplaces, award criteria, and instructions for application submission.  Additionally, applicants are required to submit a non-binding Letter of Intent to Apply by June 30, 2014. Applications are due July 10, 2014 at 1pm EST through grants.gov.

Additional Resources for Navigator Applicants

Certified Application Counselors

The Federally-facilitated Marketplace designates 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 for organizations who want to become Marketplace-designated organizations that can certify application counselors can be found at the link below. These groups might include community health centers or other health care providers, hospitals, or social service agencies.

Additional Resources for CACs

Agents and Brokers

Agents and brokers also play a key role in the Health Insurance Marketplace. To the extent permitted by states, agents and brokers play an important role in educating consumers about Marketplaces and insurance affordability programs, and helping consumers receive eligibility determinations, apply for premium tax credits and cost-sharing reductions, compare plans, and enroll in coverage. In particular, agents and brokers play a critical role in helping qualified employers and employees enroll in coverage through the Small Business Health Options Program (SHOP). Consumers may want to obtain professional advice from agents and brokers when applying for and selecting a qualified health plan. Below is a link to the CMS webpage for agents and brokers choosing to participate in Federally-facilitated Marketplaces or State Partnership Marketplaces.

Additional Resources for Agents and Brokers