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What are the differences between Navigators, Certified Application Counselors, and others assisting consumers in making health insurance decisions in the ACA’s health insurance marketplaces?

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Q: What are the differences between Navigators, Certified Application Counselors, and others assisting consumers in making health insurance decisions in the ACA’s health insurance marketplaces?

A: The Affordable Care Act (ACA) creates several new entities to advise and help consumers make health insurance purchase decisions. These entities include Navigators, Assisters, Certified Application Counselors, and Web brokers.  Here are the specifics regarding each:

Navigators are outlined in the ACA as helpers for people to enroll in coverage through the health insurance exchange, and refer or assist with Medicaid enrollment. Navigators are funded through exchanges, and regulations from the Department of Health and Human Services (HHS) are clear that anyone who gets payments from insurance companies cannot be a Navigator. Navigators also must meet cultural competency standards and go through training and certification.

To add even more help on the ground, there are Assisters (or, In-Person Assistance) as well. Like Navigators, Assisters must meet training and conflict-of-interest standards. They will fill in gaps in areas that need more enrollment assistance, or provide outreach and education about the ACA to individuals who have not traditionally had access to health insurance coverage.  Unfortunately, Assisters currently are not slated to help with enrollment in the Federally Facilitated Exchanges.

Certified Application Counselors will also help persons apply and enroll in the exchanges. Each state exchange must have a Certified Application Counselor program, with similar training and privacy standards as Navigators and Assisters.  The CAC’s will help people understand and choose the right health plan, conduct outreach,  maintain experience in eligibility, enrollment and all insurance affordability program specifications; provide information and services in a fair, impartial and culturally competent manner; and facilitate selection of a QHP.  And no worries, CAC’s will meet all privacy and security standards.

Web brokers or Web entity brokers (WBE), are entities that will tap into the Federally Facilitated Marketplace (FFM) and the data hub to assist in enrolling tax-subsidy-eligible residents in 36 states to access health coverage. The WBE’s will help individuals and families research, compare, purchase, and enroll in health coverage from insurers offering coverage through the FFM. The WBE’s will also seek agreements with states enacting their own health insurance marketplaces as well.