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'Navigators' of State Health Insurance Exchanges Prepare to Help Applicants

When enrollment in the health care law’s new insurance exchanges opens in October, the prospects for success will turn on a crucial element: people who actually understand health insurance coverage and can explain it in plain language to consumers.

Many Americans who will be signing up may never have had insurance in the past or aren’t fluent in English or might have trouble figuring out which plan will be best for their pocketbook and health condition. They probably will be using computers or paper application forms to enroll in health care coverage through the exchanges, which serve as marketplaces for the purchase of health insurance for individuals and small businesses.

The Obama administration doesn’t want them to give up in frustration.

So the states and the Department of Health and Human Services will oversee the training of what’s expected to be thousands of paid health insurance experts who will be available to guide Americans through the enrollment process. Counselors working in community health centers or hospitals also will be trained. Advocates are hoping there will be enough helpers to satisfy what could be a deluge of demand from worried and confused applicants. “It’s a challenge. It’s a huge challenge,” Kathleen Gmeiner of Ohio Consumers for Health Coverage said at a recent forum sponsored by the Kaiser Family Foundation.

Here are some questions and answers about who will be helping Americans understand their new choices:

How do “navigators” fit into the system of exchanges that was set up under the health care law?

Consumers will fill out applications either online, on paper or by phone to apply for health insurance through the exchanges. Each state will have its own marketplace and its own set of available health insurance policies; some will be overseen by the federal government and others by states.

Insurance is often hard to understand and everyone has a different situation. So the law created government-paid helpers called “navigators” who will educate consumers about how to apply and assist them through the process. Navigators won’t work on commission and they can’t favor any one insurer or be paid by insurers.

Navigators may be public or private organizations or self-employed individuals. Eligible groups include unions, tribal organizations, church groups and chambers of commerce. At least one group in every state must be a consumer-oriented nonprofit. They will advise applicants on whether they are eligible for the Medicaid program or whether they might qualify for government tax credits that will help them pay for their insurance.

Navigators are supposed to provide impartial information and guidance to consumers, not tell them which plan to pick.

Are there navigators in every state? Are there other types of helpers?

There will be navigators in the 34 states in which the federal government is running the marketplaces or the state is engaged in a partnership with the federal government. In those states, the Department of Health and Human Services is making available $54 million. The money is allocated based on the total number of uninsured people under the age of 65 in each state, and each state gets at least $600,000. Some experts are worried this won’t be enough to reach all the uninsured. Applications are due June 7.

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