Understanding the Role of Health Exchange Navigators

 Health exchange navigators would play a primary role in ensuring that the end consumers have easy access to relevant health related information and have a trouble free health plan enrollment process.

So who are these navigators? By definition, navigators serve as a guide and help people get the information they seek. Health Exchange navigators, similarly, would work as health insurance exchange guides and will help consumers learn about available health information and enroll in appropriate health plans. With millions of individuals likely to purchase insurance through the health insurance exchanges, states would need to establish a strong navigation system to guide consumers and enroll in a plan of their choice.

The Affordable Care Act has suggested various groups and profiles that may serve as reliable health exchange navigators. ACA suggests that navigators may belong to trade, industry or professional associations; chambers of commerce; community focused non-profit groups; ranching and farming organizations; licensed insurance agents and brokers and other similar entities that may serve as health exchange navigators.

Navigators would be required to meet the health exchange eligibility criteria to serve as exchange navigators. The ACA has also listed some primary responsibilities that health exchange navigators would be required to perform. Exchange navigators would be required to conduct educational sessions to raise awareness about the Qualified Health Plans (QHPs) among the consumers. They would also be required to share accurate information on participating health plans and other insurance information in completely fair and impartial manner. The navigators would also be required to help consumers approach the right channels for any plan enrollment related or other complaint or grievances. Navigators would be required to deliver information to cultural and ethnic groups in a manner and language that is easily understandable to such exchange consumers.

Despite the fact that the health insurance exchange deadline is just over a year away, there is very little information available on how different states are investing in building a strong health exchange navigator system. For most states busy with developing the technology infrastructure for the insurance exchanges and finalizing their eligibility determination modules, health exchange navigators’ network seems to have taken a back seat. This is surprising considering local community groups, brokers and agents would play a key role in spreading awareness about the upcoming health insurance exchanges among the local state residents.

Without a strong and expansive navigator system, states may find themselves at a disadvantage in terms of generating consumer interest in purchasing health insurance through the exchanges. It still remains to be seen whether states rise up to the need of the hour and succeed in building a strong health exchange navigators grid that is likely to prove valuable in driving up health exchange enrollments.