Navigator and In-Person Assistance Programs

Updated January 2013

Click here to download the publication as a PDF.

On October 1, 2013, health insurance exchanges open for business in every state. However, millions of uninsured Americans who will be able to enroll in affordable coverage through these exchanges do not know about the new benefits or how to enroll. Ensuring that enrollment assistance is available before exchanges open next year will be critical to successfully helping the newly eligible learn about and enroll in coverage.

When told about the new coverage options, 75% of the newly eligible want in-person assistance to learn about and enroll in coverage (Enroll America Research, November 2012).

Ways Exchanges Can Help Consumers Enroll

Required Enrollment Assistance Options:

  • A consumer-friendly website
  • A toll-free hotline
  • A navigator program

Additional Enrollment Assistance Options:

  • An in-person assistance program
  • Health insurance brokers/agents
  • Health care providers
  • Other stakeholders

What is a navigator?

Navigators are entities that will assist consumers and small employers with the enrollment process. They will conduct public education activities to raise awareness about the exchange, help people apply for and enroll in plans offered through the exchange, and provide referrals.

Who can be a navigator?

Community and consumer-focused nonprofit groups; trade, industry, and professional associations; commercial fishing industry, ranching, and farming organizations; chambers of commerce; unions; resource partners of the small business administration; licensed producers (i.e., insurance agents and brokers); indian tribes; state or local human service agencies; and other public or private entities or individuals that are capable of carrying out the required duties and providing information that is fair, accurate, and impartial.

What is the in-person assistance program?

In the final exchange blueprint, the Center for Consumer Information and Insurance Oversight (CCIIO) outlined an optional in-person assistance program that is distinct from the navigator program. State-based and Consumer Assistance Partnership Exchanges can obtain federal funds to create and operate these programs.

Click here to download the publication, including a table breaking down the difference between different assistance programs, as a PDF.

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