Navigators & Exchanges: Understanding the Basics

Exchanges or online health care marketplaces seek to empower the consumer. The main idea to set-up these web-based markets is to ensure that the consumer can buy health insurance after easily comparing different plans in an informed manner and is assisted in every step of the decision making process. This can be achieved when some form of consumer assistance is established. This can be done in many ways among which the navigator and assister programs are most likely to prevail.

Understand Role of Navigators in State Exchange Marketplaces

The ACA mandates presence of consumer enlightenment via the presence of Navigators who can be individuals, small businesses, unions or groups that are approved by the regulatory bodies controlling the state Exchanges. The role of navigators is rather simple, i.e. they have to offer assistance to consumers, to help people buy the most appropriate type of health plan. The role of navigator does include some challenges such as providing information in a manner that is locally applicable since every region puts forth cultural and linguistic challenges that need to be overcome.

The role of navigators becomes more challenging when they have to engage and provide information to non-traditional populations, i.e. people who typically aren’t associated with purchasing health insurance or are doing so for the first time. Here, the role of a navigator combines educating the masses about the role of Exchanges, the mandates according to which coverage can be subsidized and the advantages and urgency of getting enrolled in some form of health coverage. Navigators need to provide information about the different QHPs or publicly funded insurance like Medicaid and CHIP.

Since the Exchange seeks to engage people who are uninsured, the initial engagement section of the Navigators is also likely to include people who don’t have easy accessibility to travel. This includes North Americans living on reservations or those with serious disabilities.  

Navigators can also be constituted by private entities that will be given the freedom to interact with qualified individuals and answer typical queries such as Medicare enrollment, Medicare application or the advantages of buying insurance through new formats like Shop Exchange. The Exchange in each state is mandated to offer some sort of a Navigator program. Navigators work in close association with the enrollment assisters who function in a rather similar capacity. States can professionally engage navigators under different remuneration policies. This can include direct payroll of the exchange-governing regulatory bodies or commissions based on the quality and quantity of help forwarded.

The concept of navigator programs has also influenced the payers who are busy refurbishing their online presence, trying to make it more consumer-oriented. As a result, portals run by payers are now being turned into progressive, online marketplaces like the state Exchanges. These can be understood as private Exchanges that will now have dedicated call center functions and on-call assistance to ensure that consumers can contact at any time they feel stuck with their health care insurance shopping experience.