The Affordable Care Act requires state health insurance marketplaces to establish a “navigator” program (Section 1311(i)) that will help individuals who are eligible to purchase coverage through a health insurance marketplace learn about their new coverage options and enroll. States can award grants to entities that will provide these services, who then hire and train people navigators.
Navigators play a vital role in helping consumers prepare electronic and paper applications to establish eligibility and enroll in coverage through the Marketplaces and potentially qualify for an insurance affordability programs. They also provide outreach and education to raise awareness about the Marketplace, and refer consumers to health insurance ombudsman and consumer assistance programs when necessary.
Under current law, navigators have the following five duties:
- To conduct public education about the availability of qualified health plans.
- To distribute fair, impartial information about enrollment in qualified plans and about the availability of premium tax credits and cost-sharing assistance in the exchange.
- To facilitate enrollment in qualified plans.
- To refer people who need help resolving a problem with their health plan or with their premium assistance to a consumer assistance or ombudsman program or to another appropriate agency that can help with a grievance or appeal.
- To provide information in a culturally and linguistically appropriate manner to the population being served by an exchange.
Navigators are funded through federal grant funds and must complete comprehensive federal Navigator training, criminal background checks, and state training and registration (when applicable), prior to assisting consumers.
With that being said it hasn’t been an easy road…
On June 10, 2014, CMS published a second funding opportunity announcement (FOA) making up to $60 million in cooperative agreement funds available to Navigators in Federally-facilitated or State Partnership Marketplaces under CFDA number 93.332.
On September 8, 2014, CMS announced $60 million in Navigator Cooperative Agreement awards to entities to serve in the 34 Federally-facilitated and State Partnership Marketplaces. A list of 2014 Navigator grant recipients, , as well as their subgrantees and partner organizations, 2014 Navigator Grant Recipients can be found here: 2014 Navigator Grant Recipients. The current grant cycle runs through September 7, 2015. Entities and individuals cannot serve as federal Navigators without receiving federal grant funding from CMS to perform Navigator duties.
Navigators also have to undergo a criminal background check, and submit to fingerprint check. Before they can be licensed and trained.
Need help locating a navigator in your area who may assist you sign up for healthcare insurance coverage? Click here: Visit our Find Local Help page to search by city and state or Zip code.
Would you like to apply online? Click here: https://www.healthcare.gov/
Still need more information? Here are some helpful tips:
First get a general overview of the Marketplace.
Start with our quick guide and we’ll lay out your next steps.
- See if you qualify for savings. Check out our quick chart, which shows income ranges that qualify for savings in 2015.
- Learn how to estimate your income for the Marketplace. Make a quick ballpark estimate to help you plan before you fill out an application.
- Gather the documents you need. Use this checklist of documents you’ll need to fill out your application (PDF).
- Get email and text reminders and important information. Sign up for Marketplace emails and text messages.
- Get your questions answered. Contact the Marketplace Call Center 24 hours a day, 7 days a week.
- Find someone in your community to help you apply and enroll.
- Need definitions of basic insurance terms, like deductible, copayment, and out-of-pocket maximum? Browse our glossary.