How navigators, CAC counselors and agents differ:
- Navigators offer impartial education about exchanges and plans.
- Certified application counselors have a more limited focus on enrollment.
- Unlike Navigators and CACs, brokers and agents can recommend coverage.
- Agents with online portals are also certified to help customers enroll.
- If they’re certified, they’re trained to help enroll.
- Attitudes about the Affordable Care Act may vary.
- Regardless of who helps you, help should be free.
During the ACA implementation process, state and federal governments invested millions of dollars in online exchanges to facilitate enrollment in subsidy-eligible, ACA-compliant health plans. And over the last few years, the exchanges have been refined and upgraded to make them as user-friendly as possible.
But even with a perfectly designed, glitch-free enrollment system, many people will still want or need personal assistance with the application process and with ongoing insurance utilization questions. To fill this need, there are a variety of assisters nationwide who are trained to guide people through the process of researching and enrolling in health plans, and some can provide ongoing support after the plan is purchased.
It may be clear to you that you need help choosing a plan. What isn’t clear to many potential enrollees is how the various options for assistance – Navigators, certified application counselors, brokers, agents and enrollment consultants – differ.
Navigators offer impartial education about exchanges
The Navigator role was created for the purpose of providing impartial education and outreach about the exchanges and exchange health plans, helping applicants determine whether they qualify for subsidies or Medicaid, and assisting them in the enrollment process. Navigators are not permitted to recommend one plan over another or direct consumers towards a particular policy.
Navigators are paid by state and federal grant programs, and they cannot be compensated by the insurance companies. In September 2016, HHS announced $63 million in Navigator grants for 98 organizations working in 34 states with federally run or partnership exchanges. The grants are used to pay Navigators and maintain the Navigator programs at these organizations. (States that are running their own exchanges also have exchange-funded Navigator programs.)
But the Navigator funding that was provided in September 2017 was sharply reduced — about 40 percent lower than it had been the year before — and the lower funding was announced at the last minute, catching Navigator organizations off-guard.
In early 2016, HHS laid out enhanced requirements for Navigators – most of which go into effect for 2018 – including targeted assistance for underserved and uninsured populations, as well as post-enrollment assistance (on issues such as eligibility appeals and health insurance utilization).
So for 2018 coverage, Navigators will be able to provide more assistance than they have in the past. But the shorter open enrollment window for 2018 coverage (just over six weeks, as opposed to the three-month open enrollment period that was used in prior years), the reduced budget for Navigator organizations, and the reduction in the number of other enrollment assisters could mean that Navigator assistance is spread thinner than usual.
CACs have a more limited focus on enrollment
Certified application counselors (CACs) can also provide assistance with the enrollment process. They are similar to Navigators, but they are not required to perform outreach activities, and are not required to perform post-enrollment assistance (although they can do so if properly trained). Their role is more limited and their focus tends to be strictly on helping people enroll.
The exchange designates local “CAC organizations” (health centers, faith-based organizations, colleges, etc.) and people who are affiliated with or employed by those organizations are eligible to serve as CACs. Navigators are funded through the exchange, but certified application counselors are not. Funding for the CAC program can come from a variety of state and federal sources though, including existing public health appropriations.
Since CACs aren’t funded by the exchange, some states (Vermont is an example) are working to boost outreach to organizations that would be well served by having a CAC on staff. CACs generally serve a more focused clientelle (people who would be using the organization where the CAC is employed, such as a clinic or hospital), but relying on CACs can help a state expand the total number of people available to help with the enrollment process, without having to spend as much on the Navigator program.
Brokers and agents can make plan recommendations
Insurance brokers and agents who are certified by the exchanges can also explain plan details and help consumers determine subsidy or Medicaid eligibility, but – and this is a key difference – they can also make plan recommendations based on a client’s particular situation.
Agents and brokers continue to assist their clients after the plan is purchased, helping them sort out questions and problems regarding billing, utilization, claims, and appeals. Brokers and agents also generally carry errors and omissions insurance, and are licensed by the state department of insurance.
For health insurance purposes, independent agents and brokers are virtually the same thing, although brokers may represent more carriers or offer different types of insurance products.
Agents with online portals also certified to help
It’s worth noting that many online portals – originally designed to provide a quick health insurance quote – are now devoting more resources to phone support, with agents licensed in each state to help customers through the enrollment process. (You can call one of our partners at 1-844-608-2739 to talk with a licensed, exchange-certified brokers who can enroll you in an ACA-compliant plan.)
In early 2016, CMS published a list of frequently asked questions pertaining to agents and brokers who assist enrollees with the federally facilitated exchange.
If they’re certified, they’re trained to help enroll.
Brokers are licensed and regulated by their state Insurance Commissioner, and must comply with state requirements for continuing education that pre-date the ACA. To be able to assist consumers enrolling through the exchange, brokers must also complete the required training and be certified by the exchange.
Navigators are regulated by the exchanges, although states can impose additional training and certification requirements. For 2018 enrollment (which begins November 1, 2017), Navigators in the federally-faciliated marketplace have to complete 17 online Navigator Curriculum courses, which HHS estimates should take about 20 hours to complete (there’s an accelerated recertification process available to current Navigators; it includes a refresher course and three additional required courses).
Certified application counselors are also regulated by the exchanges. In federally facilitated exchanges, CACs are required to complete six online CAC Curriculum courses (the rest of the courses are optional-but recommended-for CACs). In states that run their own exchanges, certification requirements are up to the state and the exchange
Brokers and agents are required to maintain their licenses with the states where they sell coverage, and to be certified with the exchange (HealthCare.gov or a state-run exchange, depending on the state) if they wish to help clients enroll in exchange plans. Brokers and agents are required to completed continuing education courses in order to remain licensed and in order to maintain their certification with the exchange.
Attitudes about the Affordable Care Act may vary
Navigators and certified application counselors tend to be supportive of healthcare reform and the ACA, although many of them are relatively new to the health insurance industry, since both positions only became available in 2013.
The organizations that employ Navigators and certified enrollment counselors are often grant-funded advocacy groups, healthcare centers, universities, and public health agencies, and in many cases they’re providing invaluable in-person assistance in communities with very high uninsured rates and significant enrollment obstacles.
Brokers pre-date the ACA, and have been helping consumers obtain health insurance for decades. Some brokers have been vocal in their opposition to the ACA, and some have opted to leave the individual health insurance industry. And certainly, not all of those who remain have chosen to get certified with the exchanges. But the ones who have gotten certified are committed to reform and see it as an opportunity to help their clients rather than a hindrance.
Regardless of who helps, help should be free
So what’s the price of this advice? Your consultations are actually free.
Navigators are hourly employees, paid by state and federal exchange grant programs, and they cannot be compensated by the insurance companies.
CACs are not paid by insurance companies either. They can be hourly employees or volunteers, with a variety of public funding from outside the exchange. Many are employees of organizations such as hospitals or clinics that want to have a trained staff member who can help uninsured patients enroll in coverage.
Brokers are generally paid on commission by the insurance carriers, although some exchanges have salaried or hourly brokers as part of their staff.
But while there is a difference in how brokers and Navigators are compensated, there are never any consultation fees*, and there’s no difference in the health insurance premiums you’ll pay, regardless of whether you work with a Navigator or enrollment counselor, broker or agent – or even if you apply entirely without assistance.
* It’s possible that brokers in some areas might eventually start to charge fees as insurers reduce or eliminate commissions, but this would require regulatory changes at the state level. Louisiana implemented a law in 2017 that allows brokers to charge a fee if they want to do so, but it has to be clearly disclosed to the client and it’s unclear whether many brokers will want to incorporate this into their business model.
Your help may depend on choices you’ve made already
Regardless of whether you work with a Navigator, CAC, or an exchange-certified broker, you’ll be getting skilled help with the enrollment process. This is preferable to doing it alone, especially since your premium will be the same regardless of whether you enroll on your own or with assistance.
If you feel like you need help in choosing a plan, a broker is likely your best bet. But if you already know what you want in terms of coverage and you just need help with the application process, a Navigator or CAC might be the perfect fit.