Table of ContentsView AllTable of ContentsAssistance ProvidedTrainingWhere to FindHow Are They Paid?
Table of ContentsView All
View All
Table of Contents
Assistance Provided
Training
Where to Find
How Are They Paid?
Health insurance Navigators help people who need assistance enrolling in health coverage through theAffordable Care Act (ACA)’s health insuranceexchanges/marketplaces. They can also provide assistance with various issues that might arise after a person is already enrolled.
This article will describe how a Navigator can help people access healthcare coverage, how they are trained, how they are paid, and how to find one.
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What Assistance Can Navigators Provide?
Navigators offer a broad range of support for people who need to obtain their own health insurance. They provide outreach and education about available health coverage, and can help applicants determine whether they’re eligible forMedicaid, CHIP, orsubsidies in the marketplace. They can also provide assistance with enrollment, as well as certain post-enrollment issues.
They are particularly helpful for people enrolling in Medicaid/CHIP, as these individuals are more likely to come into contact with community-based Navigator organizations and less likely to be able to obtain help from brokers. (Brokers earn income in commissions only from insurance companies; they receive no compensation for helping people enroll in Medicaid.)
Navigators’ responsibilities have evolved over time. In 2018, the Department of Health and Human Services (HHS) added additional duties for Navigators, including targeted assistance for underserved and vulnerable/uninsured populations and post-enrollment assistance.
The post-enrollment assistance included helping consumers with appeals (for eligibility issues, claim denials, or pre-authorization denials), issues with premium payments, questions about how to use health coverage, and the basics ofhow subsidy reconciliation works.
When HHS updated the rules for 2020, it made these additional duties optional for Navigators. Navigator organizations could continue to provide more comprehensive services (i.e., beyond just helping people enroll in coverage), but they were not required to do so.
For 2022 and beyond, however, HHS has reversed the 2020 guidance related to post-enrollment Navigator assistance, making these duties a requirement for the program and expanding the range of general assistance that Navigators provide.This helps to ensure that consumers have access to help with things like the eligibility appeals process, subsidy reconciliations, and how to use health insurance once they have it.
What Training Do Navigators Receive?
The federal requirements include courses that can take anywhere from five to 20 hours of annual training, as well as certification exams for each course.The federal government provides annual recertification programs for Navigators, in addition toongoing training to keep Navigators up to date on developing issues.
The general requirements for Navigators are clarified in the Code of Federal Regulations: 45 CFR 155.210and 45 CFR 155.215.
Where Can I Find a Navigator?
You may stumble across a Navigator at a local hospital, clinic, or nonprofit organization in your community. But if you’re actively seeking assistance from a Navigator, you can start atyour state’s exchange websiteand search for enrollment assistance.
HealthCare.gov’s “find local help” toolwill show you enrollment assisters in your area. You can set it to show you all the available assisters, including brokers, or you can limit it to just Navigators andcertified application counselors(CACs).
You can also use the “Navigator Grant Recipients” links to find Navigator organizations in your state. Use the most recent link, as the participating organizations can change from one year to the next. (Note that this funding only applies to states that use the federally-run exchange; states that have their own exchanges fund their own Navigator programs, even if they rely on HealthCare.gov for enrollment. As of the 2023 plan year, there are 30 states that receive federal Navigator funding.)
How Do Navigators Get Paid?
Navigator organizations receive funding from the health insurance exchange. Unlike health insurance brokers, Navigators do not receive any sort of compensation from health insurance companies.
Federal Navigator funding has fluctuated considerably over the years, reflecting the changing administrations’ approaches to healthcare reform.
Navigator grants are provided in late summer, with funding for the upcoming year. For the 2016 and 2017 plan years (i.e., funding provided in the summer of 2015 and 2016), the federal government’s Navigator funding amounted to $63 million each year.
For the 2018 plan year, federal Navigator funding dropped to $36 million. And for the next three years (plan years 2019, 2020, and 2021), federal Navigator funding amounted to just $10 million each year. Not surprisingly, the number of Navigator organizations declined, and many rural areas of the country had no local Navigators.
But the Biden administration clarified that it was fully committed to strengthening the Affordable Care Act and Medicaid. President Biden signed an executive order to that effect in January 2021.
A few months later, HHS announced that federal Navigator funding would jump to $80 million for the 2022 plan year, with grants to be awarded in late summer 2021.
And funding was even higher in advance of the open enrollment period for 2023 coverage, with nearly $100 million in funding that was provided to 59 Navigator organizations in the 30 states that rely entirely on the federally-run exchange.This was the largest annual Navigator funding to date (here’s the list of organizationsthat received federal Navigator funding for the 2023 plan year).
And it’s noteworthy that the record-high $80 million and $100 million in funding (for 2022 and 2023) is also being spread across a smaller number of states than they used to be, as three more states—Kentucky, New Mexico, and Maine—shifted away from HealthCare.gov and began operating their own exchanges as of the 2022 coverage year.This means they now fund their own Navigator programs.
Funding for the 2024 coverage year is $98.6 million.
For the states that receive federal Navigator funding, you can see which organizations have received Navigator funding each year at CMS.gov under the “Navigator Grant Recipients” section.
Summary
Health insurance Navigators are trained and certified to provide outreach and education about health insurance coverage at no cost to those who need their help. They can help determine eligibility and assist in enrollment and issues after enrollment.
A Word From Verywell
Navigators provide essential assistance to people who might otherwise not know where to turn for help. They know their local communities well and are skilled at helping vulnerable populations secure coverage, especially in programs like Medicaid and CHIP, where enrollment assistance may be needed.
If you’re struggling to make sense of the health coverage options available to you, or simply don’t know where to turn for help, a Navigator might be just the resource you need.
13 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Cornell Law School, Legal Information Institute.42 U.S. Code § 18031 - Affordable choices of health benefit plans.KFF.Consumer assistance in health insurance: evidence of impact and unmet need.Centers for Medicare and Medicaid Services.Patient Protection and Affordable Care Act; Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving Health Insurance Markets for 2022 and Beyond Final Rule. September 17, 2021.Centers for Medicare & Medicaid Services.Marketplace training overview.Cornell Law School, Legal Information Institute.45 CFR § 155.210 - Navigator program standards.Cornell Law School, Legal Information Institute.45 CFR § 155.215 - Standards applicable to navigators and non-navigator assistance personnel carrying out consumer assistance functions under §§ 155.205(d) and (e) and 155.210 in a federally-facilitated exchange and to non-navigator assistance personnel funded through an exchange establishment grant.Centers for Medicare and Medicaid Services.2022 CMS Navigator Cooperative Agreement Awardees.IHC Specialty Benefits.What type of health insurance exchange does my state have?.The White House.Executive order on strengthening Medicaid and the Affordable Care Act.Centers for Medicare & Medicaid Services.HHS announces the largest ever funding allocation for Navigators and releases final numbers for 2021 Marketplace open enrollment.Centers for Medicare and Medicaid Services.Biden-Harris Administration Makes Largest Investment Ever in Navigators Ahead of HealthCare.gov Open Enrollment Period. August 26, 2022.Centers for Medicare & Medicaid Services.IE-HBE-21-001 state exchange modernization grant program.Centers for Medicare & Medicaid Services.Marketplace Plan Year 2024 open enrollment fact sheet.
13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Cornell Law School, Legal Information Institute.42 U.S. Code § 18031 - Affordable choices of health benefit plans.KFF.Consumer assistance in health insurance: evidence of impact and unmet need.Centers for Medicare and Medicaid Services.Patient Protection and Affordable Care Act; Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving Health Insurance Markets for 2022 and Beyond Final Rule. September 17, 2021.Centers for Medicare & Medicaid Services.Marketplace training overview.Cornell Law School, Legal Information Institute.45 CFR § 155.210 - Navigator program standards.Cornell Law School, Legal Information Institute.45 CFR § 155.215 - Standards applicable to navigators and non-navigator assistance personnel carrying out consumer assistance functions under §§ 155.205(d) and (e) and 155.210 in a federally-facilitated exchange and to non-navigator assistance personnel funded through an exchange establishment grant.Centers for Medicare and Medicaid Services.2022 CMS Navigator Cooperative Agreement Awardees.IHC Specialty Benefits.What type of health insurance exchange does my state have?.The White House.Executive order on strengthening Medicaid and the Affordable Care Act.Centers for Medicare & Medicaid Services.HHS announces the largest ever funding allocation for Navigators and releases final numbers for 2021 Marketplace open enrollment.Centers for Medicare and Medicaid Services.Biden-Harris Administration Makes Largest Investment Ever in Navigators Ahead of HealthCare.gov Open Enrollment Period. August 26, 2022.Centers for Medicare & Medicaid Services.IE-HBE-21-001 state exchange modernization grant program.Centers for Medicare & Medicaid Services.Marketplace Plan Year 2024 open enrollment fact sheet.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Cornell Law School, Legal Information Institute.42 U.S. Code § 18031 - Affordable choices of health benefit plans.KFF.Consumer assistance in health insurance: evidence of impact and unmet need.Centers for Medicare and Medicaid Services.Patient Protection and Affordable Care Act; Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving Health Insurance Markets for 2022 and Beyond Final Rule. September 17, 2021.Centers for Medicare & Medicaid Services.Marketplace training overview.Cornell Law School, Legal Information Institute.45 CFR § 155.210 - Navigator program standards.Cornell Law School, Legal Information Institute.45 CFR § 155.215 - Standards applicable to navigators and non-navigator assistance personnel carrying out consumer assistance functions under §§ 155.205(d) and (e) and 155.210 in a federally-facilitated exchange and to non-navigator assistance personnel funded through an exchange establishment grant.Centers for Medicare and Medicaid Services.2022 CMS Navigator Cooperative Agreement Awardees.IHC Specialty Benefits.What type of health insurance exchange does my state have?.The White House.Executive order on strengthening Medicaid and the Affordable Care Act.Centers for Medicare & Medicaid Services.HHS announces the largest ever funding allocation for Navigators and releases final numbers for 2021 Marketplace open enrollment.Centers for Medicare and Medicaid Services.Biden-Harris Administration Makes Largest Investment Ever in Navigators Ahead of HealthCare.gov Open Enrollment Period. August 26, 2022.Centers for Medicare & Medicaid Services.IE-HBE-21-001 state exchange modernization grant program.Centers for Medicare & Medicaid Services.Marketplace Plan Year 2024 open enrollment fact sheet.
Cornell Law School, Legal Information Institute.42 U.S. Code § 18031 - Affordable choices of health benefit plans.
KFF.Consumer assistance in health insurance: evidence of impact and unmet need.
Centers for Medicare and Medicaid Services.Patient Protection and Affordable Care Act; Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving Health Insurance Markets for 2022 and Beyond Final Rule. September 17, 2021.
Centers for Medicare & Medicaid Services.Marketplace training overview.
Cornell Law School, Legal Information Institute.45 CFR § 155.210 - Navigator program standards.
Cornell Law School, Legal Information Institute.45 CFR § 155.215 - Standards applicable to navigators and non-navigator assistance personnel carrying out consumer assistance functions under §§ 155.205(d) and (e) and 155.210 in a federally-facilitated exchange and to non-navigator assistance personnel funded through an exchange establishment grant.
Centers for Medicare and Medicaid Services.2022 CMS Navigator Cooperative Agreement Awardees.
IHC Specialty Benefits.What type of health insurance exchange does my state have?.
The White House.Executive order on strengthening Medicaid and the Affordable Care Act.
Centers for Medicare & Medicaid Services.HHS announces the largest ever funding allocation for Navigators and releases final numbers for 2021 Marketplace open enrollment.
Centers for Medicare and Medicaid Services.Biden-Harris Administration Makes Largest Investment Ever in Navigators Ahead of HealthCare.gov Open Enrollment Period. August 26, 2022.
Centers for Medicare & Medicaid Services.IE-HBE-21-001 state exchange modernization grant program.
Centers for Medicare & Medicaid Services.Marketplace Plan Year 2024 open enrollment fact sheet.
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