What Are Insurance “Navigators” Under the Affordable Care Act?

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As of January 2014, most Americans will be required to carry health insurance under the new healthcare mandate.  In response, some states, including California, Oregon and New York, have created health insurance exchanges: marketplaces where consumers can compare plans and rates and obtain coverage. Many states have chosen not to set up a health insurance exchange and instead are allowing the federal government to operate their exchange.

Outreach to ensure that consumers are aware of the exchanges will be very important for achieving the ultimate goal of the Affordable Care Act (ACA)—to reduce the number of uninsured individuals.  To do this, the ACA has made it a requirement for every state to establish a “navigator” to help consumers.

What is a Navigator?

Navigators are individuals or organizations, including trade and professional associations, churches—even ranching and farming groups—who work for the ACA’s “navigator” program to help guide consumers through the state and federal health insurance exchanges.  Navigators must be affiliated with certain community organizations according to the final rule released by the Centers for Medicaid and Medicaid Services (CMS) in July, and traditional insurance agents cannot be selected as navigator workers.

Navigators must undergo at least 30 hours of training before they can counsel individuals, and they are limited to the information they can provide. They can discuss:

  • Qualified plans and affordability programs under the exchange 
  • Eligibility for tax credits and subsidies 
  • The tax implications of different options 
  • Referrals to other consumer assistance programs/state agencies for health insurance related issue. 

Navigators will have to meet federal requirements, as well as any state-specific requirements, and some states may require that navigators undergo more than 30 hours of training. After the health insurance exchanges begin enrolling individuals after October 1st, it will become clearer how well the navigators are able to meet the needs of consumers.

Benefit Packages has been helping individuals, seniors and businesses find affordable California health insurance plans with reputable carriers like Blue Cross of California for over 20 years. We will be an exchange certified agency and can help you find your best options for coverage under the new healthcare law.  Visit our website or call us for more information at 1-800-356-3615.