Monday, November 19, 2012

Agent or Navigator?

With the re-election of President Obama and with the Democrat controlled Senate, the Affordable Care Act (sometimes referred to as Obamacare) will become the law of the land. 

Today we will address the role of Navigators:

The ACA requires all state Exchanges to fund what will be called Navigators.  The Navigator’s job is to provide individuals and families with the information necessary to determine which health insurance option best fits their needs and then help them enroll in their plan of choice.

The ACA recognizes that different types of Navigators will be needed to help people access coverage through the Exchanges. In Section 1311(i), the ACA lists a variety of groups that could serve the functions of Navigators and suggests that multiple Navigators will be needed to ensure success. According to the ACA, Navigators may be community and consumer-focused non-profit groups; trade, industry, professional associations; commercial fishing industry organizations; ranching and farming organizations; chambers of commerce; unions; partners of the Small Business Administration (SBA); licensed insurance agents and brokers; and other entities capable of carrying out the required duties.

It would seem that the traditional role of an insurance agent/broker will be replaced by this new position. 

To become a Navigator the individual or group must have an existing relationship, or could establish relationships, with employers and employees, uninsured and underinsured consumers, or self-employed individuals likely to qualify to enroll through the Exchange.
 Navigators may not receive any direct or indirect payments from health insurers and insurers are explicitly prohibited from being Navigators. Navigators are funded through grants provided by state Exchange funds.   This is to avoid a conflict of interest, but no directive has been issued to clarify if this applies to new business being written through the exchange or all business including any that may already exist in an agent or brokers practice.

We will post new information on the role of Navigators as it becomes available.  Subscribe to this blog to receive updates.


1 comment:

  1. Texas governor Rick Perry has sent a letter to Health and Human Services head Kathleen Sebelius that in part read: "This is a federally-mandated exchange with rules dictated by Washington," "It would not be fiscally responsible to put hard-working Texans on the financial hook for an unknown amount of money to operate a system under rules that have not even been written." This does not, however, mean Texas will not have an exchange.
    The ACA requires states to establish an insurance exchange by one of three methods: States may decide to create and administer a state-run exchange; states may decide to partner with the federal government to create and administer an exchange; or states may allow the federal government to create and administer an exchange in their state. Regardless of the choice selected, an insurance exchange will be created.