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Helping Consumers Choose the Right Health Plan Under Health Reform

April 16, 2013 at 10:12 AM

In less than six months, millions of uninsured Americans will be able to enroll in private health coverage through health reform’s new health insurance exchanges.  Health reform requires exchanges to create “navigator” programs to help individuals enroll, but groups representing insurance agents have expressed concern that navigators could take business away from agents and that unqualified navigators could provide poor-quality assistance; some states are considering limiting the kinds of help that navigators can give or even making it difficult for anyone besides an insurance agent to become a navigator.  A proposed rule from the Department of Health and Human Services (HHS) would address some of these issues.

The rule, issued April 5, would prevent states from barring navigators from performing critical functions, including helping people apply for coverage and then educating them on how to select particular health insurance plans in the exchanges that will best meet their needs.  It would also prohibit states from requiring navigators to be licensed insurance agents or brokers — a requirement that would rule out many non-profit organizations with experience in helping qualified people obtain public benefits.

In addition, the rule would create robust training standards to ensure that navigators provide high-quality assistance and strong conflict of interest standards to ensure that navigators act in consumers’ best interests.

HHS also recently announced that it will award $54 million to navigators in 34 states with federal exchanges.  At least two types of entities will serve as navigators in each state, including at least one community- and consumer-focused nonprofit.

Together, the proposed navigator rule and the federal funding will help the navigator program provide needed assistance so people can choose the plan that’s right for them.