By Randy Dotinga
WebMD Health News
Reviewed by Lisa Zamosky
Sept. 20, 2013 -- Oct. 1 will bring the opening of health insurance Marketplaces in every state, where people can buy coverage to begin in 2014.
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Most Americans won't need to do anything because they have health insurance through their employer or the government. But people who do use the Marketplaces are likely to find them complicated at best and bewildering at worst.
Standing by will be thousands of paid and unpaid helpers to guide you through the process. Some work for the Marketplaces and some do not.
1. What kind of help is available?
There will be four types of helpers available:
- Navigators, who work for the Marketplaces. They will teach you about the Marketplaces and help you enroll. Navigators will be available in all states.
- In-person assisters, who are similar to navigators.
- Certified application counselors, who will help you enroll for health coverage through the Marketplaces. They work for hospitals or nonprofit groups.
- Agents and brokers. The rules for them are different in each state.
2. What does the navigator program do?
The navigator program helps anyone who wants to get insurance through a Marketplace. The goal of navigators is to help "consumers understand the basics of insurance, how it works, and how they enroll in the Marketplace," says Elizabeth Calhoun. She is a professor of health policy and administration at the University of Illinois at Chicago. "They'll help people digest information so they can make the best decisions."
Navigators will be required to take 20 hours of training. They must be impartial and are not allowed to recommend specific plans.
3. Why should I get help from a navigator?
Anyone can visit a Marketplace and buy coverage on their own. But it is complicated, and help from navigators is expected to make a big difference.
For example, some Americans will need help figuring out whether to take a federal subsidy (financial aid) when they pay their premiums or later as a rebate when they file their taxes, says David Adler. He is a program officer at the Robert Wood Johnson Foundation who monitors health insurance issues.
Family relationships can create confusion, too. For example, he says, a couple with children from another marriage may need help to figure out eligibility for coverage.
Calhoun says the navigators can also get the word out about how many people -- like families of four making less than $94,200 -- are eligible for financial aid.
4. What other kinds of helpers will be available?
Other helpers include in-person assisters and certified application counselors, who are available only in certain states.
In-person assisters are similar to navigators. The difference is their jobs are funded differently from navigators.
Certified application counselors work for community health centers, hospitals, nonprofits like churches and labor unions, and non-federal government agencies. They will help you understand, apply, and enroll for health coverage through the Marketplace. They must complete 5 hours of training and comply with privacy laws and other standards.
5. What about insurance agents and brokers?
Agents and brokers can also help people sort out their options in the Marketplaces. The rules for agents and brokers are different in each state. They all must go through the same training as navigators, though.
6. Will there be enough helpers for everyone?
It's not clear. The work of navigators has become a political issue in the continuing battle over health care reform.
At least 17 states have set up rules for navigators or are thinking about doing so. Some states are requiring navigators to be licensed or certified, and several have approved rules limiting the guidance they can give to consumers.
Supporters of the Affordable Care Act, like professor Robert Field, think the requirements are an attempt to make it hard for people to become navigators and enroll consumers. It "doesn't make sense" to require them to need the same licenses as insurance agents and brokers because they serve a different role, he says. Field is a professor of law and health management policy at Drexel University.
But the citizens, officials, and lawmakers who have pushed for restrictions argue that they're protecting consumers. "If we are going to have to endure the Affordable Care Act, then we need to make sure that people aren't taken advantage of," Arkansas State Sen. Jason Rapert, a Republican, says in an interview with Pew Charitable Trusts.
7. Where can I find help?
Start at healthcare.gov, the federal government's web site for information about Marketplaces. If you live in a state that is running its own Marketplace, it will take you to that web site. If you live in one of the 34 states where the federal government is running the Marketplace, it has a lot of information to help you.
You can also go to localhelp.healthcare.gov, which gives you a list of groups that can help near your home. Just enter your ZIP code or city and state. Hospitals, clinics, religious organizations, and community groups are expected to sponsor events where assisters will be present.
SOURCES: Elizabeth Calhoun, professor of health policy and administration, University of Illinois, Chicago. David Adler, program officer, Robert Wood Johnson Foundation. Robert Field, professor of law and health management policy, Drexel University. ModernHealthcare.com: Reform Update: HHS to Award $54 Million for navigator training." Kaiser Health News: "White House Pushes Back Against Fraud Fears Of Obamacare Opponents." Center for Medicare and Medicaid Services: "Assistance Roles to Help Consumers Apply & Enroll in Health Coverage Through the Marketplace," "Certified application counselor organization." Stateline (Pew Charitable Trusts): "Health Insurance Navigators Draw State Scrutiny." Robert Wood Johnson Foundation: "Navigators and In-Person Assistors: State Policy and Program Design Considerations." Marketplace.cms.gov: "Common Questions and Answers on Designation of Certified Application Counselor (CAC) Organizations in Federally-Facilitated Marketplaces."
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