The Obama administration proposed guidelines on Wednesday for “navigators” who will assist people who buy health insurance on virtual marketplaces under President’s Obama’s health care law.
The marketplaces, or “exchanges,” established by the Affordable Care Act are state-based portals where persons without employer-based insurance can shop among competing private health plans. Participation in the exchanges is set to begin on Oct. 1. Insurance coverage from the exchanges will take effect on Jan. 1.
More than half of the states asked the federal government to set up an exchanges for them. Other states are running them on their own or in a partnership with Washington.
The exchanges will award grants to so-called navigators, which are organizations that are supposed to provide “fair and impartial” information to consumers as they wade through the exchanges’ requirements.
The navigators will be especially helpful to consumers who are disabled, do not speak English or are not familiar with how health insurance works, according to the Centers for Medicare and Medicaid Services.
“Navigators will be an important resource for consumers who want to learn about and apply for coverage in the new Marketplace,” CMS Acting Administrator Marilyn Tavenner said Wednesday.
The navigators are supposed to help people with their eligibility applications and enrollment through the exchange, but not determine whether participants qualify for tax credits or select a qualified health plan for them.
Rather, the state-run or federally facilitated exchanges will determine eligibility and offer services such as a call center for customer assistance.
Navigators must develop expertise in the exchanges and avoid conflicts of interest, the rule said. For example, navigators cannot issue health insurance or be paid “directly or indirectly” by a health insurance issuer in connection with their enrollment of individuals or employees into health plans.