Navigators and Assisters in the Third Open Enrollment Period

Navigators and in-person assisters continue to play a key role in helping consumers get coverage through the insurance Marketplaces.
Members of the public sitting at tables at a polling center, signing in to vote and have flu vaccinations.

There is still work to be done in educating the public on the requirement to have insurance, assisting with enrollment, and helping people understand how to use their insurance once they purchase a policy.

What’s the issue?

The Affordable Care Act (ACA), also known as Obamacare, has been fully implemented for more than a year. The combination of Medicaid expansion in almost thirty states, enrollment in Marketplace plans, and allowance of adult children to remain on their parents’ health plans until age twenty-six has resulted in the lowest uninsurance rate in more than a decade. Yet as we enter the third open enrollment period for Marketplace plans, there is still work to be done in educating the public on the requirement to have insurance, assisting with enrollment, answering difficult eligibility questions, engaging hard-to-reach populations, and helping people understand how to use their insurance once they purchase a policy.

The role of navigators and in-person assisters (IPAs) in performing these functions is as important as ever. People who have trouble with the online Marketplace or need more assistance with their individual situation can turn to navigators and IPAs to walk them through the eligibility and enrollment process. Navigators are individuals or community-based organizations funded by federal or state grants to help guide consumers in the Marketplace, assist with subsidy applications, and enroll in a health plan. IPAs perform many of the same functions as navigators, but they are funded through separate grants or contracts.

A third category of enrollment assisters, certified application counselors, help people fill out applications and compare health plans but perform more limited functions than navigators and IPAs. Since the first open enrollment period, navigators’ and IPAs’ roles have evolved to include reenrollment efforts, educating consumers on how to use their insurance, and addressing postenrollment questions and problems. Not only is the consumer assistance process time and resource intensive, but navigators and assisters do not necessarily have the expertise to address some of the new issues they are facing.

What’s next?

Given the lack of understanding of the ACA by most Americans, it is clear that the work of navigators and assisters is far from complete. Leveraging relationships with brokers can help fill some gaps in consumer assistance and leave time for navigators to focus on the hard-to-reach populations and tough cases. More specific training on the nuances of eligibility determination, immigration, and policy changes would help navigators address some of the hard questions they are facing.

The Department of Health and Human Services (HHS) just announced $67 million in grant funding for navigators, restoring the level of funding from the first year of open enrollment. Moreover, the possibility of a three-year grant instead of twelve-month, nonrenewable grants should bring peace of mind to navigator entities that worry about the sustainability of their work.