Affordable Care Act
Health Insurance Navigators
Updated on March 15, 2024
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Health insurance navigators act as resources for consumers when shopping for health insurance. Health insurance navigators provide unbiased information to help people find plans that fit their needs.
When it comes to shopping for health insurance, finding the best plan at the right price can be difficult. However, navigators are one resource you have to make it easier.
A health insurance navigator’s number-one priority is to provide you with accurate and unbiased information. As such, they are trained and experienced in providing people with a wide range of insurance plans to choose from and providing assistance during the health insurance application process. If you’re wondering whether or not to use a health insurance navigator, we’ve outlined some of the things you’ll want to consider.
What is a health insurance navigator?
If you need help enrolling in a health plan, the Affordable Care Act (ACA or “Obamacare”) gives you the option of working with an experienced, licensed health insurance agent or someone from the ACA’s navigator program. Health insurance navigators are not a licensed insurance agents, but they are trained to help consumers look for health insurance through the Marketplace free of charge.
Are health insurance navigators qualified?
Health insurance navigators need to be qualified and trained to help others during the application process, from choosing the right plan to filing the correct paperwork. An ACA navigator is appointed by the state to help people during the Medicare or Medicaid application process and can help guide people to the right resources.
Fortunately, health insurance navigators need to be trained in competency and must pass certain standards, including 45 CFR 155.210 and CFR 45 155.215. In addition, health care navigators are also paid by the state and federal governments. Therefore, they must be well-trained when hired for the position of Medicare navigator.
How do health insurance navigators help people?
The Affordable Care Act was passed to help everyone have access to health care insurance. Unfortunately, not everyone understands how to navigate the process of choosing the right health care plans, filing paperwork, or paying for health insurance. Because of this, the position of health insurance navigator was created.
Health insurance navigators work for organizations that help people apply for health insurance. In addition, an ACA navigator can help people find the best plans that work for them and inform them of other qualifications, such as if they qualify for Medicare or Medicaid insurance. Health insurance navigators can help people find the best plan based on individual health insurance costs.
With an upswing in enrollment in marketplace plans—increasing by 2.8 million this year—a lot of people have been in need of help when finding insurance.
Health insurance navigators vs. licensed insurance agents
Licensed insurance agents are able to make personalized recommendations based on your needs. However, navigators cannot. While navigators are a source of unbiased information about insurance plans and can walk you through the steps, they can’t advise you in choosing a specific plan that aligns with your needs.
eHealth has licensed insurance agents that can provide you with a more in-depth recommendation for your future health insurance plan. And, they can still help you move through the process before and after you’ve signed up for insurance coverage.
How does health insurance navigation work?
When you meet with a health insurance navigator, they will sit with you and talk to you about your income level, health goals, family members, and what type of insurance you need. For instance, if you have a pre-existing medical condition, you might need a plan with more coverage.
Your health insurance navigator will then help you find plans and fill out the paperwork to apply for coverage. They will not make the decision for you but can serve as a health insurance guide and point you in the right direction.
How to find a health insurance navigator near you
Use the “Find Local Help” tool on the healthcare.gov website by inputting your state or ZIP code. You will then be guided to your state’s healthcare page or redirected to a list of navigators available to help you in your area. Alternatively, you can view the list of areas that are funded for health insurance navigators at cms.gov and contact them separately.
However, you can also work with a licensed insurance agent at eHealth for no additional cost while enjoying the additional guidance they can offer.
How are health insurance navigators funded?
Health insurance navigators are funded both federally and statewide. There have been several recent changes to health insurance navigator funding.
In August of 2017, the Department of Human and Health Services (HHS) cut funding for the ACA’s navigating program in light of findings about the effectiveness of the navigator program. The HHS reports that navigators received $62.5 million for 2017 open enrollment. The average cost of each enrollment was $768, and only one-in-five navigators achieved the projected goals of enrollment. The HHA also claims that those who were enrolled with the help of navigators only constituted 1% of total enrollees.
However, in 2022, funding for insurance navigators has been reinstated for 2023 open enrollment. The Biden-Harris administration recently approved $98.9 million in funding for 59 health navigator organizations around the United States. The funding includes $12.5 million to support additional direct outreach, education, and enrollment activities.
If your state has another type of program, such as California, which uses Covered California, health insurance navigators might receive funding from the state government and taxes.
Get help from our licensed agents to find affordable insurance
Don’t struggle with the complex insurance shopping and application process on your own. If you need help choosing a health insurance plan, eHealth has licensed insurance agents that can help find you the most affordable insurance plans that meet your coverage needs. Get started by speaking with one of our licensed agents today.
This article is for general information and may not be updated after publication.