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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?

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) created several new entities to advise and help consumers make health insurance purchase decisions. These entities include Navigators, Assisters, and Certified Application Counselors. Health insurance brokers, including web brokers, pre-date the ACA and continue to help people enroll in health insurance now that the ACA has been implemented. Here are the specifics regarding each:

The Navigator position was created by the ACA to provide helpers for people to enroll in coverage through the health insurance exchange, and refer or assist with Medicaid enrollment. Navigators are funded through by the exchanges (here are the organizations that received Navigator grants in 2015 in the 34 states that use the federally-facilitated marketplace). 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. Starting in 2018, Navigators will provide more ongoing assistance to consumers after the enrollment process is complete.

To add even more help on the ground, there are non-Navigator Assisters (or, In-Person Assistance) as well. Like Navigators, Assisters must meet training and conflict-of-interest standards. They 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. In the federally-facilitated marketplace, non-Navigator assisters must complete the same training as Navigators.

Certified Application Counselors (CACs) 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 (although the training and certification requirements are less rigorous for CACs).  The CACs 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. CACs are not required to begin providing additional post-enrollment assistance starting in 2018, although they will be able to do so if properly trained.

Brokers and web brokers pre-date the ACA; they’ve been helping clients purchase health insurance for decades. With the rise of the internet, many brokers became web brokers over the last couple decades, providing their clients with user-friendly, side-by-side plan comparison tool and online applications for health insurance. Brokers continue to serve an important role in helping their clients enroll in ACA-compliant health insurance. Unlike Navigators, in-person assisters, and CACs, brokers can help people enroll in plans both on and off the exchange. Brokers are licensed by the states in which they work, and are paid commissions by health insurance carriers. In order to be certified with the exchange (either the federally-facilited marketplace or a state-run exchange), a broker must complete the exchange certification process in addition to the state licensing requirements. Brokers continue to provide ongoing support to their clients after the enrollment process is complete.

There’s no charge to consumers for using assistance with the enrollment and plan utilization process. Regardless of whether you receive help from any of these sources or enroll completely on your own, the price you’ll pay for your coverage is exactly the same.