Affordable Care Act

Health Insurance Navigators

Updated on November 15, 2019


What is a health insurance navigator?

Insurance Agents vs Navigators

If you need help enrolling in a health plan, the Affordable Care Act (ACA or “Obamacare”) gives you the option of working with an experienced, licensed health insurance agent or someone from the ACA’s navigator program.  A health insurance navigator is not a licensed insurance agent, but he or she is trained to help consumers look for health insurance through the Marketplace free of charge.

In August of 2017, the Department of Human and Health Services’ (HHS) cut funding for the ACA’s navigating program, in light of findings about effectiveness of the navigator program. The HHS reports that navigators received $62.5 million for 2017 open enrollment. The average cost of each enrollment was $768, and only one-in-five navigators achieved projected goals of enrollment. The HHA also claims that those who were enrolled with the help of navigators only constituted 1% of total enrollees.

Although the funding for navigators has been cut for 2018, they are still available to help with enrollment on health insurance Marketplaces.  If you don’t know how a licensed insurance agent differs from a health insurance navigator, or the best way to leverage each, you may end up chasing down a resource that doesn’t meet your needs.

That’s why eHealth created a simple checklist that compares what health insurance navigators and licensed agents can and cannot do to assist you when you enroll in a health plan.

Changes to navigator funding

As mentioned above, the Navigator program is not as heavily funded as it was from its start. Let’s look at the history of how funding was planned for this program, and how things came to change.

In 2015, the Centers for Medicare and Medicaid Services (CMS) signed an agreement to fund the Navigator programs for three years. According to the Kaiser Family Foundation  the Navigator programs were required to set goals a report performance throughout the year. The submissions of these performance reports and future plans to CMS helped approve and determine the amount of funding for the year.

Since every year the budget was different, the Navigator programs were given a Notice of Awards (NOA) sometime before Open Enrollment for the year began. In May 2017, Navigator programs were informed that there would be $60 million for their third-year funding. When August came around, CMS announced that Navigator funding would be decreased by more than 40% and that funding would now be based on performance rather than “enrollment goals”.

Although funding has decreased, the Navigator programs plan to operate in 2018.
This article is for general information and may not be updated after publication.

Related Articles

We’ll let you know when we publish anything new.