Even Congress agrees, Obamacare -- the Affordable Care Act - is really complicated. So complicate in fact, that helping people deal with the law's controversial "individual mandate" will require a group of specially trained and certified Obamacare "navigators."
Scheduled to take effect on January 1, 2014, the Supreme Court-approved Obamacare individual mandate requires all U.S. citizens and legal permanent residents to have health insurance or pay a penalty on their income taxes. The ability of the government to fund other provisions of Obamacare depends heavily on cost savings realized by having most people covered by health insurance.
According to the U.S. Centers for Medicare and Medicaid Services (CMMS), as many as 18 million Americans may be eligible for tax credits to help pay for their required health insurance.
Also See: Obamacare Employer Mandate DelayedToo help uninsured people comply with the individual mandate, the Affordable Care Act (ACA) establishes health insurance Markets or Exchanges in each state where individuals and small businesses can compare and purchase qualifying health plans available in their area. The ACA requires all of the state insurance Exchanges to be open for business by October 31, 2013.
The ACA also requires each of the insurance Exchanges to establish a Navigator program to help consumers understand the new levels of coverage options and find the most affordable plan that meets their health care needs.
Who Can be a Navigator?
Under the ACA, navigator groups may be community based non-profit groups; consumer advocacy groups; trade, industry, professional associations; chambers of commerce; unions; Small Business Administration partners; licensed insurance agents and brokers; and other entities capable of carrying out the required duties.
The ACA requires each Exchange to have two navigator groups, at least one of which must be a non-profit, consumer-focused organization not directly tied to the insurance industry.
In August 2013, the CMMS awarded nearly $60 million in cooperative government grants to help the insurance Exchanges find, train and certify navigators.
Roles of the Navigators
Under the ACA, each insurance Exchange will have two certified navigator groups that will be expected to provide "fair, impartial, and accurate information that assists consumers with submitting the eligibility application, clarifying distinctions about [qualified health plans], and helping qualified individuals make informed decisions during the health plan selection process." The navigators will also be expected to provide special to non-English speaking and disabled consumers.
Basically, the navigators are there to help uninsured people meet their Obamacare obligation by enrolling in the qualified health insurance plan that best meets their medical needs at an affordable cost.
Perhaps most importantly, the navigators are expected to be able to assist people who have never had health insurance and are unfamiliar with things like insurance premiums, deductibles, out-of-pocket costs and covered medical procedures.
A Kaiser Family Foundation study has projected that at least 65% of people enrolling through an Exchange will have been previously uninsured.
Rules of the Navigators
Since the navigator groups may - but are not required to - employ licensed insurance agents or brokers, the federal regulations created to implement and enforce the ACA emphasize impartiality in how they recommend health plans to consumers.
"The navigator must not have a personal interest in the coverage choices made by individuals or employers who receive the navigator's assistance," states the regulation, "More specifically, with respect to the assistance offered by a navigator to a small employer, a navigator should not have a personal interest in whether a small employer choose to self-insure its employees, or chooses to enroll in fully-insured coverage inside or outside the exchange."
Specifically, whether a navigator is a licensed insurance agent or not, they:
- May not be employed by any of the insurance companies that might be recommended by the Exchange;
- May not get pay, rewards or any form of compensation from any of those companies;
- Must disclose any and all health insurance companies they have worked for in the last five years;
- Must disclose any other non-health lines of insurance they might sell while employed as a navigator; and
- Must swear to abide by all impartiality and conflict of interest standards enforced by the Department of Health and Human Services.
It is never good when a law that could impose fines on a large number of people confuses a large number of people. Apparently such is the case with Obamacare.
According to a Kaiser Foundation Health Tracking poll conducted in April 2013, four in ten adult Americans (42%) are not aware the Affordable Care Act is still in effect, including 12% who think Congress has repealed the law, 7% who believe it was overturned by the Supreme Court and 23% who simply "don't know whether or not the ACA remains law."
Also See: Obamacare Card Calls are Scams"At this stage, when outreach efforts are just beginning in some states, and others have yet to get started, one in five (22 percent) say they've heard at least 'some' about the health insurance exchanges," noted the Kaiser Foundation.
Worst of all, the Kaiser poll showed that 20% of lower-income Americans and 12% of the uninsured - Obamacare's two main target groups - said they had heard "more than a little" about the law, their obligations under the law or the insurance Exchanges.