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What is a healthcare navigator?

The lowdown...
  • A health care navigator is a trained health insurance assistance person
  • They have knowledge and resources to help applicants with routine to difficult application situations
  • Navigators fill the gap between applicants with little prior exposure to healthcare and the experts needed for complex cases
  • Navigators have served in every insurance cycle since 2014
Navigators were part of the initial rollout of the Affordable Care Act. The new health reform law had some unusual requirements, and the federal government saw to it that there were trained resources available to help customers find their way.

In addition to navigators and assistance personnel, health insurance agents and brokers helped consumers enroll in health insurance through the Marketplace.

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Reform in Health Industry

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The new concepts that stirred questions among the public in the initial roll out and the first year of the Affordable Care Act required assistance to promote public understanding. They required assistance to complete selections of health insurance successfully.

The public got some new ideas and requirements in the passage of the Affordable Care Act that required interpretation and assistance when applied to the individual, family, and group circumstances.

Navigators, counselors and insurance professionals provided guidance on the below-described subjects.

  • Affordable Insurance – the law provided exemptions when applicants could not find affordable plans in their areas. These included plans that cost more than eight percent of annual family income and employer plans that cost more than nine and one-half percent of family annual income.
  • Advanced Premium Tax Credits – required consideration of long-term income and a balancing of premium costs against overall costs of insurance. Navigators and insurance professionals advised applicants on the ways to lower and control costs.
  • The Mandate – and penalty required attention from assistance counselors, navigators, and insurance professionals. Many people considered paying the penalty for the lack of insurance, and those risks were part of the discussion.
  • Tobacco Cessation, Age, and Location – are the permissible factors that allow insurers to raise rates for some applicants.
  • Cost-sharing and Cost-sharing Reduction Assistance – health insurance differs from other insurance in the continuous line of consumer expenses required to get and use health insurance.

Deductibles, Copays, and Coinsurance

The confusion of these terms and their roles in the health insurance plans causes confusion and sometimes contributes to customer frustration. Deductibles still are the triggers that start insurance company payments.

Copays are small fixed fees, and of covered benefits.

Many policies and types of insurance use these terms in non-standard ways. Some plans use low-cost network services and reduce the role of consumer payments to encourage greater use of the network.

To the Present Day

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This is the last year of the Obamacare before its redirection by the Republican Congress, and there are still navigators on the standby to help consumers find the answers to their questions and problems.

Navigators perform the below-listed functions.

  • Provide a presence by phone, person, online or email at the consumer’s point of need
  • Handle problems caused by the interpretation or usage of rules and procedures

The Individual Mandate

Navigators were needed in addition to their skills by the force of the individual mandate. This key requirement in the Affordable Care Act made the law work.

No one was free to ignore the requirement for health coverage. T

hey faced a penalty if they did not get and keep qualified health insurance. Given the mandate, the federal government brought a focus on preparing consumers to get covered.

The rollout through the calendar year 2017, the navigators have guided consumers from the initial signup trough resolving issues on health insurance contracts.

Navigators Were Sometimes Banned

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So deep was the opposition to health insurance in some states, that the navigators were banned by the insurance officials.

They determined that thousands of people might be disadvantaged in the application process if left on their own to sort through the screens for the application. This was also a reflection of the value of the navigators.

They could guide applicants in the following ways:

  • selecting a policy
  • establishing tax credits
  • getting in line for Marketplace assistance and subsidies
  • answering questions by telephone, email, and mail to help applicants found answers to their issues and questions
  • solving problems that arise in interpreting rules and the application of rules
  • providing an in-person presence at designated locations

Resources Needed to Help

There are some sources of knowledge and information in the application process for Obamacare coverage.

In the initial period, agents and brokers formed a resource group that many private and public entities used to get ahead of the learning curve.

The agents and brokers were familiar with the insurance business and followed the introduction of the health reform laws. They were invaluable resource particularly in the early years of the Affordable Care Act.

Community-Based Training and Services

The community-based organizations in some related areas of public health services and public health advocacy provided training and navigator assistance.

Called the CACs, these organizations connected to community groups and helped provide an accessible local presence for assistance in the sign-up process. The Certified Assistance Counselors (CACs) offered an in-person dimension for assistance that was direct and effective.

A Resource in the Right Place

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Considerable resources were needed to guide millions of applicants through the screens and windows that one must pass to apply for insurance.

The nation’s applicants for health insurance received assistance from the latest resource groups of navigators, counselors, and insurance professionals. The undertaking of a national health insurance program was no small feat.

Open Enrollment for the 2017 plan year began on November 1, 2016. The ready cadre of licensed and experienced health insurance professionals once again provided a solid resource for consumers.

These experienced brokers and health insurance carrier agents extended the benefits of their knowledge and insurance backgrounds to clients and members of the public.

These groups of trained and qualified individuals provided assistance to consumers. They served as the below-listed functions during the 2017 Open Enrollment Period.

  • Navigators
  • In-person assistance personnel
  • Certified application counselors

Employer Coverage

Empoyer-sponsored coverage is another area that receives help from the navigators. The employer plans offer significant choices, too.

They sometimes involve employer assistance for expenses in addition to health insurance for all eligible employees. Employer coverage is also an area of expertise for brokers and agents.

These resource groups help navigate the offerings on behalf of their family and individual clients. They help create plans for small, medium, and large businesses.

Navigators Guided Consumers to Select Their Plans

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The navigators, assistance personnel, and insurance professionals combined into a resource that helped millions of consumers. The task of selecting health insurance was not easy for millions.

Many applicants had no prior experiencing with health insurance. The navigators helped consumers look at premiums and beyond to find plans that met their needs.

Enabling comparison shopping was the essential contribution of the navigators. They helped applicants reach the point of understanding their options and choices for Obamacare coverage.

The task of selecting a qualified health plan was simplified by the navigation to the decision stage.

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