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5 Types of Obamacare Health Plan Application Help

5 Types of Obamacare Health Plan Application Help

Posted Oct 31, 2016 by Author

The launch of the Affordable Care Act’s Health Insurance Marketplace meant many Americans were able to buy health insurance for the first time—a process that can be overwhelming a lot of people. There is a lot of information swirling around about plan options, premium rates, tax credits and application deadlines. Many of us have questions.

Fortunately, there are helpers available—in-person, on the phone, over chat—to assist you in selecting, applying for and enrolling in an Obamacare health plan.

We've put together a brief guide to the five types of assistance for individuals and families, small businesses and small business employees shopping the Affordable Care Act's state-based and federally facilitated exchanges. Most of them are different names for what are essentially similar roles. Here is a little background information to help you understand what they do and the nuances that distinguish them.

1. Marketplace Navigators

Obamacare Marketplace Navigators include individuals and organizations that have been trained to assist people shopping the new health insurance marketplace. They can help consumers that buy their own health insurance, as well as small businesses and their employees, sort through their plan options and complete eligibility and enrollment forms. As stated at HealthCare.gov, they are required to be unbiased and provide services to consumers for free. States are required by law to have a Navigator program and must fund the program from a source "other than their federal exchange establishment grants," according to the Georgetown University Health Policy Institute, whose report "Designing Navigator Programs" calls Navigators the exchange's "customer service team." As outlined by the Department of Health and Human Services, Navigator duties include the following:

  • Maintaining expertise in eligibility, enrollment, and program specifications

  • Conducting public education activities to raise awareness about the Marketplace

  • Providing information and services in a fair, accurate, and impartial manner, including information that acknowledges other health programs such as Medicaid and CHI

  • Facilitating selection of a QHP [qualified health plan]

  • Providing referrals for enrollees with questions, complaints, or grievances about their health plan, coverage, or a determination under such health plan or coverage to any applicable office of health insurance consumer assistance or health insurance ombudsman or any other appropriate state agency or agencies

  • Providing information in a culturally and linguistically appropriate manner, including to persons with limited English proficiency

  • Ensuring accessibility and usability of Navigator tools and functions for persons with disabilities

States may decide to call their Navigators by another name. These helpers are available to consumers purchasing exchange-based coverage.

2. Application Assisters

Application Assisters—also known as In-Person Assisters—are a lot like Navigators. Like Navigators, they are trained and certified to help individuals and families as well as small businesses and their employees and follow the competencies listed above. State-based exchanges have an option to provide Assisters; however, states with a federally facilitated exchange will have a federally facilitated Assistor program.

The key difference between Assisters and Navigators is funding. Assister programs may be funded by federal exchange establishment grants. In states where both programs are present, the Assister program must somehow distinguish itself from the Navigator program, perhaps by serving a specific population. These helpers are available to consumers purchasing exchange-based coverage.

3. Certified Application Counselors

The Affordable Care Act requires that states have a Certified Application Counselor program. This program does not receive federal funding and operates in a similar manner to the Assister and Navigator programs. As with the other programs, counselors must receive training and certification. The key difference is that Certified Application Counselors include staff from a community health center or other health care provider, hospital, non-federal governmental or nonprofit social service agency in states with federally facilitated and state-based exchanges. In other words, the CAC programs are strictly organizational rather than also existing at an individual level.

According to Marketplace.CMS.gov, organizations that want to train staff and volunteers to be part of the CAC program must:

  1. Have processes in place to screen staff to make sure that they protect consumer information

  2. Engage in services that position them to help those they serve with health coverage issues

  3. Have experience providing social services to the community

These helpers are available to consumers purchasing exchange-based coverage.

4. Government agencies

These may include State Medicaid and the Children¹s Health Insurance Program (CHIP) offices and assist people eligible for such programs.

5. Producers

Health insurance producers (i.e., agents and brokers) can also help consumers shopping on or away from the state-based and federally facilitated health insurance exchanges. Those who have registered with the exchanges have completed special training certifying them to sell the marketplace coverage. Agents and brokers can also help you find additional coverage such as critical illness plans, temporary health insurance, dental insurance and more.

Still confused? In the end, you can rest assured that there are helpers available. They are trained and certified, and they can assist a diverse array of populations. The key to finding the help you need when shopping for health insurance is to know where to look. Use the Agent Finder or visit your state's exchange website to find help near you.


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