In-Person Assistance in the Health Insurance Marketplaces
- Key Resources
- Certified Application Counselors (CACs)
- Enrollment Assistance Personnel (EAP) Program
- Agents and Brokers
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 and the remaining states opted for the Federally-facilitated Marketplace (FFM).
No matter what state they live in, consumers can receive help as the apply for and enroll in coverage through the Marketplace.
Open Enrollment for the 2024 plan year begins November 1, 2023 and individuals will again be able to provide assistance to consumers in a number of different ways: by becoming Navigators of certified application counselors. In addition, agents and brokers will still be able to help consumers enroll in health insurance through the Marketplace.
- CMS-9955-F: Patient Protection and Affordable Care Act; Exchange Functions: Standards for Navigators and Non-Navigator Assistance Personnel; Consumer Assistance Tools and Programs of an Exchange and Certified Application Counselors - Opens in a new window
- CMS-9949-P: Patient Protection and Affordable Care Act; Exchange and Insurance Market Standards for 2015 and Beyond
- CMS-9949-F:Patient Protection and Affordable Care Act Standards for 2015 and Beyond
- CMS-9937-F: Final HHS Notice of Benefit and Payment Parameters for 2017
- CMS-9930-F: Final HHS Notice of Benefit and Payment Parameters for 2019
- CMS-9926-F: Final HHS Notice of Benefit and Payment Parameters for 2020
- CMS 9914-F: Final HHS Notice of Benefit and Payment Parameters for 2022 (Part I)
- CMS 9914-F: Final HHS Notice of Benefit and Payment Parameters for 2022 (Part 2)
- CMS-9906-F: Patient Protection and Affordable Care Act; Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving Health Insurance Markets for 2022 and Beyond Final Rule
- Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2024
- CMS Enrollment Assister Bulletin: 2023-01-Guidance Regarding Training, Certification, and Recertification for Navigators and Certified Application Counselors in the Federally-facilitated Exchanges (PDF)
Each year, the Centers for Medicare & Medicaid Services (CMS) makes grant awards to organizations who serve as Navigators in FFM states. Navigators play a vital role in helping consumers prepare 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 operate year-round—increasing awareness among the remaining uninsured about the coverage options available to them, helping consumers find affordable coverage that meets their needs, and assisting consumers beyond the enrollment process to ensure they're equipped with the tools and resources needed to utilize and maintain their health coverage all year. Navigators must complete comprehensive federal Navigator training, criminal background checks, and state training and registration (when applicable), prior to assisting consumers.
On August 25, 2023, CMS awarded $98.6 million in Navigator cooperative agreement awards to 57 returning organizations who will continue serving as Navigator awardees in states with a FFM. These awards support the work of organizations that offer assistance to consumers navigating, shopping for, and enrolling in health insurance coverage for plan year 2024.
Note: This year’s awards included partial funding for the three (3) returning Navigator organizations serving as Navigator awardees in the state of Georgia for the remainder of PY 2023 to support Medicaid unwinding efforts in the state. The state of Georgia has received conditional approval from CMS to transition from an FFM to a State Based Marketplace on the Federal Platform (SBM-FP) for PY 2024. As such, CMS will not fund Navigator organizations operating in the state of Georgia for PY 2024.
A list of 2023 Navigator grant recipients can be found here: 2023 Navigator Grant Recipients (PDF). The 2023 Navigator awards are for the third and final 12-month budget period of a 36-month period of performance, which runs August 27, 2021 through August 26, 2024. Entities and individuals cannot serve as Navigators in the FFM without receiving federal grant funding from CMS to perform Navigator duties.
- 2021 Navigator Notice of Funding Opportunity (NOFO) Frequently Asked Questions for Applicants (PDF)
- 2021 Overview of Applying for a Federal Cooperative Agreement (PDF)
- Example of 2020 Navigator Privacy and Security Terms and Conditions (PDF)
- 2021-2022 Navigator Supplemental Funding Amounts (December 2021) (PDF)
- Upper Limits for Available 2021 Navigator Supplemental Funding (PDF)
- 2013 Navigator Grant Recipients (PDF)
- 2014 Navigator Grant Recipients (PDF)
- 2015 Navigator Grant Recipients (PDF)
- 2016 Navigator Grant Recipients (PDF)
- 2017 Navigator Grant Recipients (PDF)
- 2018 Navigator Grant Recipients (PDF)
- 2019 Navigator Grant Recipients (PDF)
- 2020 Navigator Grant Recipients (PDF)
- 2021 Navigator Grant Recipients (PDF)
- 2022 Navigator Grant Recipients (PDF)
- 2023 Navigator Grant Recipients (PDF)
Certified application counselor designated organizations (CDOs) are a vital component of the assister community. In the Federally-facilitated Marketplaces (FFMs), CDOs oversee certified application counselors (CACs) who are trained and able to help consumers seeking health insurance coverage options through an FFM. Organizations that wish to become CDOs designated by the Centers for Medicare & Medicaid Services (CMS) to serve in an FFM must submit an online application and enter into an agreement with CMS. These groups might include community health centers or other health care providers, hospitals, or social service agencies.
- Guidance on Certified Application Counselor Program for the Federally Facilitated Marketplace including State Partnership Marketplaces (PDF)
- Apply to be a Certified Application Counselor (CAC) Organization
The Centers for Medicare & Medicaid Services (CMS) has implemented a multi-pronged approach to improve Medicaid coverage transitions, including a ramped-up direct outreach effort to streamline the consumer experience. CMS has reestablished and revamped the Enrollment Assistance Personnel (EAP) program, with EAPs serving as "mobile assisters' and helping consumers navigate coverage transitions from Medicaid into Qualified Health Plans (QHPs) through the Federally-facilitated Marketplace (FFM). EAPs operate under a contracted assistance model under which Cognosante LLC has been retained to conduct direct assister-to-consumer outreach alongside Navigator grantees in FFM states to help consumers maintain continuity of coverage.
Through ongoing training and resources, EAPs are prepared to help consumers who lose Medicaid coverage to facilitate a seamless transition to Marketplace coverage. CMS is also ensuring the EAPs' efforts are coordinated with other assisters in the community to help consumers understand basic concepts and rights related to health coverage, provide enrollment assistance, and work with individuals to link coverage to care. EAPs will maintain a critical physical and virtual presence in target areas of the following states: Arizona, Florida, Illinois, Louisiana, Michigan, Montana, North Carolina, Oklahoma, Tennessee, Texas and Utah. The EAP target areas were identified by CMS as areas of greatest need for enrollment assistance and are referenced in the table below.
If you have any EAP related questions, please contact us at EAPQuestions@cms.hhs.gov
Additional Resources for Consumers Seeking EAP Assistance
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.
Note: People using assistive technology may not be able to fully access information in these files. For assistance, please e-mail AltFormatRequest@cms.hhs.gov.