Skip to Main Content
 

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 2017 plan year begins November 1, 2016 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 September 2, 2016, the Centers for Medicare & Medicaid Services (CMS), announced $63 million in Navigator grant awards to returning and new organizations to serve as Navigators in the 34 states with a Federally-facilitated Marketplace. These awards will support local in-person assistance to help consumers navigate, shop, and enroll in the wide variety of Marketplace coverage options.

This year, 96 returning organizations and two new organizations in the state of Hawaii received a grant award. This is the second year of a three-year funding cycle for the returning grantees that currently provide local in-person assistance. The 2015 Navigator Funding Opportunity Announcement required applicants to submit a proposal covering the full 36-month project period. Funding is released in 12-month increments as CMS continually assesses Navigator grantees’ performance for ongoing support. A list of 2016 Navigator grant recipients can be found here: 2016 Navigator Grant Recipients.  The current grant cycle runs through September 1, 2018. Entities and individuals cannot serve as federal Navigators without receiving federal grant funding from CMS to perform Navigator duties.

 

Additional Resources for Hawaii 2016 Navigator Applicants

Additional Resources for Navigator Grantees

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