Health Insurance Exchanges: Health Insurance Navigators and In-Person Assistance
Abstract
The 2010 Patient Protection and Affordable Care Act (ACA, P.L. 111-148) allows certain individuals and small businesses to buy health insurance through state exchanges, beginning on October 1, 2013. The exchanges are not themselves insurers, but rather are special marketplaces where insurance firms may sell health policies that meet set, federal guidelines. As of September 2013, 16 states and the District of Columbia had secured Department of Health and Human Services (HHS) approval to create their own exchanges, 7 to enter into partnership exchanges, 26 to have federally facilitated exchanges, and 1 to have a state-based Small Business Health Options Program (SHOP)/federally facilitated individual exchange. An estimated 24 million individuals are expected to secure coverage through the exchanges by 2022. The ACA requires exchanges to perform outreach to help consumers and small businesses make informed decisions about their insurance options, including the creation of navigator programs. Navigators are to carry out public education activities; provide information to prospective enrollees about insurance options and federal assistance; and examine enrollees eligibility for other federal or state health care programs, such as Medicaid. Navigators may assist consumers in comparing insurance plans, but may not determine their eligibility for subsidies or enroll them in plans functions that are left to the exchanges. A variety of organizations may become navigators, including labor unions, trade associations, chambers of commerce, and other entities. Navigators may not be health insurers or take compensation from insurers for selling health policies. Navigators will be required to have 20-30 hours of training on consumer privacy, exchanged-based insurance offerings, and other issues. HHS in August 2013 allocated $67 million in 12-month grants for navigators at federally facilitated and partnership exchanges.
Document Details
- Document Type
- Technical Report
- Publication Date
- Sep 25, 2013
- Accession Number
- ADA591023
Entities
People
- Suzanne M. Kirchhoff
Organizations
- Library of Congress