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Navigator

What are Navigators?

The Navigator position was created by the Affordable Care Act to provide helpers for people to enroll in coverage through the health insurance exchange, and refer or assist with Medicaid enrollment.

Navigators are not licensed health insurance brokers, so they cannot recommend one plan over another or direct consumers towards a particular policy. Instead, they provide consumers with general information that can make it easier to understand what’s available, in terms of coverage and financial assistance. Navigators are paid by state and federal grant programs, and they cannot be compensated by the insurance companies.

What training and qualifications do Navigators have?

Navigators must meet cultural competency standards and go through training and certification. Standards and regulations for the Navigator program are outlined in 45 CFR 155.210 and CFR 45 155.215.

State-run exchanges do their own certification and training for Navigators. CMS conducts the certification and training for Navigators in states that use HealthCare.gov; you can see specific training information and requirements here.

What assistance can Navigator provide?

Navigators provide enrollees with unbiased information about the health insurance exchange and the health plans that are available. They can help applicants determine whether they qualify for subsidies or Medicaid, and assist with the enrollment process.

As of 2018, HHS enhanced the requirements for Navigators. The new requirements, detailed in 45 CFR 155.210(e)(9), ensured that Navigators would provide targeted assistance for underserved and uninsured populations, and post-enrollment assistance for things like eligibility appeals, subsidy reconciliation, and health insurance utilization questions.

In the guidelines for 2020, HHS reversed course somewhat on this, making those duties optional, rather than required, for Navigator organizations. But in the proposed rules for 2022 and beyond, HHS is calling for the prior requirements to be reinstated. If finalized, this would mean that Navigators will once again be required to provide post-enrollment assistance with things like eligibility appeals and how to utilize health coverage after a person has already enrolled.

How are Navigators funded?

Navigators are funded by the federal government in states that use the federally-run exchange (HealthCare.gov) and by the states that run their own exchange platforms.

The Biden administration has dramatically increased federal Navigator funding, providing $80 million to be distributed in states that use HealthCare.gov, in advance of the open enrollment period that starts in the fall of 2021. The previous high had been $63 million, provided in the fall of 2016. The Trump administration had subsequently reduced federal Navigator funding down to only $10 million per year, so the funding available in the fall of 2021 will be eight times more than has been available for the past few years.

And that’s despite the fact that fewer states need to rely on the federal Navigator funding: New Jersey and Pennsylvania both transitioned away from HealthCare.gov in the fall of 2020. And New Mexico, Kentucky, and Maine are all planning to do so in the fall of 2021, operating their own exchanges and funding their own Navigator programs. This makes the $80 million in federal Navigator funding stretch even further.

You can see the lists of Navigator grant recipients for each year on this page.

How can I find a Navigator in my area?

You can enter your zip code on HealthCare.gov’s “find local help” tool. If you’re in a state that runs its own exchange, you’ll be directed to your state’s exchange website. If you’re in a state that uses HealthCare.gov (36 states as of 2021; 33 states as of 2022), the tool will show you who can help you enroll in your area. You’ll need to select the “assisters” filter to see only Navigators and enrollment counselors (if you don’t limit it, the tool will show you everyone who is certified to help you, including brokers and agents; note that brokers and agents are licensed by the state and are allowed to provide specific plan recommendations, whereas Navigators are not).

You can see a list of the organizations that have received federal Navigator grants on this page. That page will be updated in August/September 2021 with Navigator funding grants for the 2022 plan year; it will include more organizations and larger grant amounts than prior years. For the 2021 plan year, these are the organizations that received federal Navigator grants.

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