Enrollment Assisters & Exchanges: Understanding the Basics

To ensure that the reach of the Exchange can be maximized and populations that have traditionally remained out of the health insurance realm can be now insured, the Navigator Program is further strengthened with the presence of Enrollment Assisters. These are essentially individuals who will be responsible for ensuring that people who tend to be uninsured unless they are called upon and talked into being enrolled within the state’s exchange.

Health Exchange Enrollment Assisters

Enrollment Assisters are primarily responsible for bringing the uninsured and the underinsured section of the population under the health insurance umbrella. The enrollment assister is responsible for explaining the program eligibility in its entirety. Though this also includes discussing the eligibility criteria across different private health insurance plans listed on the Exchange, the program eligibility duties are mainly focused on educating about programs like the Medicaid and CHIP. An enrollment assister might typically be required to talk about Medicare eligibility, enrollment repeatedly or explain how cost sharing can be done when enrolled with Medicaid or CHIP.

Exchange assisters need to explain the qualified health plan or the QHP. This includes guiding the audience towards the web portal of the Exchange, any physical office or address at which correspondence can be made, walk-in locations, information kiosks, presence across community centers and other state agencies that are involved with the Exchange marketplace.

When interacting with employers, this duty might translate into guiding the person towards the most appropriate section of the Exchange like the shop exchange which is applicable to employers for seeking benefits defined as a part of the small business health options program for better employee benefit management.

An Enrollment Assister is expected to be well versed with the industry terminology, particularly various nomenclatures that are used within the health insurance niche and those related to the Exchange. For instance, people who are seeking health insurance for the first time might get confused between premiums and deductible or might need guidance to understand how the Exchange website can be used as an insurance quote engine. An enrollment assister is typically not expected to interact with prospective insurers to discuss about exchange eligibility but should have answers to any questions about Medicare application or how to file an application when enrolling for a health care insurance plan.

Exchange Assisters and Dispute Resolution

This is an important aspect of the duties handled by an exchange assister, i.e. helping the consumers in their disputes with carriers. This role requires knowledge about filing of papers required to escalate an issue or directing consumers to the respective agency like the DOI or a specific department within exchange’s premises that looks into such matters.

Enrollment Assisters are expected to be individuals, public entities or communities, though the chances of individuals taking up this role are rather high. Under any circumstances, the Enrollment Assister cannot be a health insurer or someone who is likely to have a bias or preference for health insurance companies.