This Robert Wood Johnson Foundation-Health Affairs policy brief describes the different roles of navigators and assisters for enrolling applicants for health insurance through the health insurance marketplaces authorized by the Patient Protection and Affordable Care Act (ACA).
Navigators are individuals or community-based organizations funded by federal or state grants to help consumers use or “navigate” the health insurance marketplaces (including the marketplace enrollment websites), assist with applications for subsidies available through the marketplaces, and apply for and enroll in health plans offered by the marketplaces. There are common (30 hour) training and annual certification requirements for all navigators, regardless of whether they are working with the federally-facilited health insurance marketplace or one of the state-based health insurance marketplaces. They must be paid with operational revenues from the health insurance marketplaces, which means that, until the marketplaces are operating, few navigator programs are actually operational. The navigator program is similar to to the State Health Insurance Assistance Program (SHIP), which has provided similar assistance in every state to seniors and individuals with disabilities regarding enrollment, coverage, and benefits in the Medicare program.
Assisters perform the same functions as navigators but may be funded by ACA funding available to establish the health insurance marketplaces. In other words, assisters may be funded now, rather than waiting for operational revenues from the marketplaces. Unfortunately, this distinction based solely on funding sources has added to the confusion about these roles.
A third category of “helpers” are certified application counselors, generally based in community-based organizations. The organization itself must be certified (meet minimum training requirements) but neither the organization nor the individual certified application counselors are paid for their assistance. The most common certified application counselor would be a staff health insurance specialist or eligibility case worker at a federally-funded community health center or a hospital.
Finally, there has arisen tension between these new ACA-created roles and traditional insurance brokers and agents (sometimes called “producers”), who receive commissions from health insurance plans for individuals they assist with enrollment in those plans. Since brokers and agents are heavily regulated by state insurance commissioners/departments, there have been calls and state legislation to similarly regulate navigators and assisters. It remains unclear how these state laws and regulations might conflict with the ACA, and limit the effectiveness of navigators and assisters.