Health Care Exchange Navigators

Posted by Marla Roshkoff - 25 April, 2013


Under health care reform, individuals will be able to purchase health insurance through marketplaces known as Health Care Exchanges. Each state must offer an Exchange by January 1, 2014. If the Exchange is not operated by the state, it will be operated by the federal government.

The Affordable Care Act requires states to provide assistance to consumers purchasing coverage through an Exchange. One such form of assistance is the creation of a Navigator to assist with the purchasing of Exchange-based coverage.

Navigators are intended to provide “fair and impartial” information to consumers about health insurance in general, and more specifically about the coverage offered through the state Exchange. The Department of Health and Human Services has issued proposed regulations describing standards that Navigators must satisfy.

The proposed regulations provide that Navigators must be knowledgeable about eligibility and enrollment rules and procedures, but may not make eligibility determinations or actually select plans for or enroll consumers. Since Navigators must be impartial, insurance companies may not be Navigators and a Navigator may not receive compensation from an insurance company.

The guidance offers detailed conflict of interest standards that will apply to Navigators and their personnel. These standards would require a Navigator to attest that the Navigator does not have a prohibited relationship with an insurer or the insurance industry. There are also standards for training and certification.

Navigators may be a welcome assistance for consumers when navigating the health care reform process, including the evaluation of Exchange-based coverage. The new proposed regulations indicate that the government is trying to keep Navigators impartial and helpful for the consumer purchasing experience.

Topics: Health Care Reform (ACA)

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