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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 2016 plan year begins November 1, 2015 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 April 15, 2015, CMS published a third funding opportunity announcement (FOA) making up to $67 million in cooperative agreement funds available to Navigators in Federally-facilitated or State Partnership Marketplaces. The complete FOA can be found by visiting http://www.grants.gov/ and searching for CFDA number 93.332. The FOA provides detailed information on applicant eligibility requirements, a listing of eligible states with a Federally-facilitated or State Partnership Marketplace, award criteria, and instructions for application submission.  Additionally, applicants are required to submit a non-binding Letter of Intent to Apply by June 3, 2015. Applications are due June 15, 2015 at 1pm EST through grants.gov.  The current grant cycle runs through September 15, 2015. Entities and individuals cannot serve as federal Navigators without receiving federal grant funding from CMS to perform Navigator duties.

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