People across the US have been signing up for health insurance under the Affordable Care Act in droves, many with the help of Certified Application Counselors (CAC’s) and Marketplace Navigators. They’ve been a key part of the process since the beginning, providing a human face to the process that was a logistical nightmare when it was first rolled out in October 2013.
Counselors and Navigators go through a lot of training and a certification process, that require extensive criminal background checks and fingerprinting so they can assist people find the right health coverage while safeguarding and protecting their vital health information.
In many cases they must also be licensed by their State Insurance department.
Certified Applications Counselors (CAC’s) and Navigators have been a part of the health care insurance process from the beginning and are responsible for significantly changing the healthcare landscape.
So what do CAC’s and Navigators do exactly and how do they differ? Very good question.
The Affordable Care Act (ACA) creates several new entities to advise and help consumers make health insurance purchase decisions. These entities include Navigators, Assisters, Certified Application Counselors, and Web brokers.
Here are the specifics regarding each:
Navigators are outlined in the ACA as helpers for people to enroll in coverage through the health insurance exchange, and refer or assist with Medicaid enrollment. Navigators are funded through exchanges, and regulations from the Department of Health and Human Services (HHS) are clear that anyone who gets payments from insurance companies cannot be a Navigator. Navigators also must meet cultural competency standards and go through training and certification.
To add even more help on the ground, there are Assisters (or, In-Person Assistance) as well. Like Navigators, Assisters must meet training and conflict-of-interest standards. They will fill in gaps in areas that need more enrollment assistance, or provide outreach and education about the ACA to individuals who have not traditionally had access to health insurance coverage. Unfortunately, Assisters currently are not slated to help with enrollment in the Federally Facilitated Exchanges.
Certified Application Counselors will also help persons apply and enroll in the exchanges. Each state exchange must have a Certified Application Counselor program, with similar training and privacy standards as Navigators and Assisters. The CAC’s will help people understand and choose the right health plan, conduct outreach, maintain experience in eligibility, enrollment and all insurance affordability program specifications; provide information and services in a fair, impartial and culturally competent manner; and facilitate selection of a QHP. And no worries, CAC’s will meet all privacy and security standards.
Another big difference has to do with funding. Funding: Navigators are specifically funded through either HHS or HRSA grants. CAC designated organizations and individual CACs will not be funded through the Marketplace. They may seek funding from outside sources, such as other available federal, state, or private funds.
With the deadline beginning Jan. 1, 2014, Obamacare will require almost all Americans to have health insurance or face tax penalties.
Every state will have its own insurance marketplace where uninsured Americans can compare and purchase private health insurance, choosing from plans that meet federal specifications. These exchanges will also inform people if they qualify for a federal subsidy to pay for their coverage and whether they also qualify for Medicaid benefits and how to sign up for those.
CAC’s and Navigators are intended to help people through the process.
“A lot of people are understandably confused with co payments, co-insurance, some of the insurance terms. Navigators and CAC’s help consumers understand key provisions of the Affordable Care Act. So education is a large part of a CAC and Navigators job”, said Stanley Smith of Phoenix, Arizona. Adding: “they will never charge you for their service.”
So how do consumers apply?
There are four ways a consumer can apply for insurance coverage:
Online – www.healthcare.gov/get-coverage/
Phone – 1-800-318-2596, 24 hours a day, 7 days a week
Need a Paper Application – Available to download at marketplace.cms.gov/applications-and-forms/marketplace-application-for-family.pdf
No matter which way you choose to enroll, with or without the assistance of CAC’s and Navigators you will need to fill out a single Marketplace application to find out if you qualify for a health plan with premium tax credits and other savings based on your income, or free or low-cost coverage through Medicaid and the Children’s Health Insurance Program (CHIP).