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What is a health insurance navigator?

Written by: Gabrielle Smith
August 9, 2021 at 8:05 AM

If your employer offers a health reimbursement arrangement (HRA), you’re likely going to be shopping for an individual health insurance plan on the federal or state exchanges, also known as the Health Insurance Marketplaces.

If you’ve never chosen your own health insurance plan before, there are several ways to get help, including health insurance navigators. In this article, we’ll go over what a health insurance navigator is, how they’re different from agents and brokers, and how they can help you find a health insurance plan that’s right for you and your family.

Watch our video for more tips on how to choose the right health insurance plan for you

What is a health insurance navigator?

A health insurance navigator is an individual or entity that’s trained to help consumers, small businesses, and their employees shop for health coverage options through the Marketplace, as well as fill out their eligibility and enrollment forms.

By law, health insurance navigators are required to be unbiased when offering their services, which are completely free to all consumers. In addition, navigators must complete federal navigator training, criminal background checks, and state training and registration (when applicable), before they can assist consumers.

The Affordable Care Act requires state Health Insurance Marketplaces to establish a “navigator” program that will help individuals who are eligible to purchase coverage through a Health Insurance Marketplace learn about their new coverage options and enroll in a plan.

Grants can also be awarded to entities that agree to provide these services. For example, in 2020 the Centers for Medicare & Medicaid Services (CMS) awarded $10 million in navigator grant awards to 30 organizations who agreed to serve as navigators in federally-facilitated Marketplace states.

What does a health insurance navigator do?

Under current law, navigators have the following five duties:

  1. Conduct public education about the availability of qualified health plans
  2. Distribute fair, impartial information about enrollment in qualified plans and about the availability of premium tax credits and cost-sharing assistance in the exchange
  3. Facilitate enrollment in qualified plans
  4. Refer people who need help resolving a problem with their health plan or with their premium assistance to a consumer assistance or ombudsman program, or another appropriate agency that can help with a grievance or appeal
  5. Provide information in a culturally and linguistically appropriate manner to the population being served by an exchange

Who can become a health insurance navigator?

The law lists a number of different kinds of entities that could become navigators, including:

  • Community- and consumer-focused nonprofits
  • Trade, industry, and professional associations
  • Commercial fishing, ranching, and farming organizations
  • Chambers of commerce
  • Unions
  • Small Business Administration resource partners
  • Licensed insurance agents and brokers
    • If a licensed health insurance agent or broker serves as a navigator, this disqualifies them from acting as a traditional producer (selling policies on or off the exchanges and receiving commissions)

In addition, in order to be eligible to receive navigator grants, an entity must meet the following criteria:

  • Establish relationships
    • The entity must already have relationships, or be readily able to establish relationships, with the employer or employees, consumers (including uninsured and underinsured consumers), or the self-employed individuals they’re serving
  • Capable of performing duties
    • The entity must be capable of performing the duties of a navigator, described above
  • Meet the following standards established by the Secretary of HHS
    • Navigators are qualified and licensed (if appropriate)
    • Navigators avoid conflicts of interest
    • Navigators are not health insurers
    • Navigators don’t receive direct or indirect compensation from an insurer in connection with enrollment of any exchange-eligible individuals or employers in a qualified health plan
  • Deliver fair and impartial information
    • The Secretary and states will develop standards to ensure that navigators deliver fair, impartial, and accurate information

How are health insurance navigators different from agents and brokers?

While navigators, agents, and brokers all offer similar services, there are a few differences that make navigators stand out. First and foremost, navigators are there to help you solely with shopping for a plan on the government exchanges—nowhere else. Agents and brokers, on the other hand, can also help you enroll in off-exchange plans.

In addition, agents and brokers are able to make personal recommendations and act as an advocate for you if you run into trouble with an insurance company. Navigators aren’t able to make these kinds of personal recommendations, and will need to refer you to another appropriate agency if you have a problem with an insurance company.

The following chart helps break down the major similarities and differences between health insurance navigators and health insurance agents and brokers:

 

Health insurance navigators

Health insurance agents/brokers

Are their services free?

Yes

Yes

Can they help you apply for a premium tax credit?

Yes

Yes

Can they help you understand plans on government exchanges?

Yes

Yes

Can they help you understand plans that aren’t on government exchanges?

No

Yes

Can they offer recommendations based on your personal needs?

No

Yes

Can they act as an advocate if you have problems with an insurance company?

No

Yes

Are they required to be licensed in every state?

No

Yes

Are there other ways I can get help shopping for health insurance?

If your employer is administering your HRA with PeopleKeep, then you also have access to the licensed professionals at KindHealth—a health insurance concierge service that offers one-on-one assistance and recommendations for the best insurance plan for your needs and budget.

Learn how KindHealth can help find the right health insurance plan for you

Conclusion

Whether it’s your first time shopping for your own health insurance plan, or you’d just like a little extra help, health insurance navigators are a great resource to consumers exploring the federal and state exchanges for a health insurance plan. Their free services are open to everyone, taking the stress and confusion out of navigating the world of health insurance.

This article was originally published on February 26, 2013. It was last updated August 9, 2021.

Topics: Group Health Insurance, Health Insurance Marketplace, Health Insurance

Additional Resources

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