Browse by Category

Organizations that provide consumer assistance for individuals and small businesses wanting to purchase private insurance through the marketplaces for themselves or, in the case of employers, for their employees. Their primary responsibility is to facilitate enrollment of consumers in health insurance plans offered through the marketplaces. The Affordable Care Act (ACA) requires the use of trained navigators to provide in-person education, and eligibility and enrollment assistance; and permits the use of trained in-person assisters and application counselors. The operator of the marketplace determines the process for establishing and managing the navigator program. Operations will vary depending on the model selected by the jurisdiction. Choices include a federally operated (or federally-facilitated) marketplace, a federal/state partnership or a state operated marketplace.

Programs mandated by the Affordable Care Act (ACA) that help individuals who want to purchase insurance, and small businesses that need to provide health insurance for their employees, understand the qualified private health plans that are available within the marketplace and guide them through the enrollment process. The navigator conducts public education activities to raise awareness about the marketplace; distributes fair, accurate and impartial information concerning enrollment including information that acknowledges other health programs such as Medicaid and the Children’s Health Insurance Program (CHIP), and the availability of premium tax credits and cost-sharing reductions; provides referrals for consumers with a grievance, question or complaint; and offers information that is culturally and linguistically appropriate to meet the needs of the population served by the marketplace. Navigators are trained to offer expertise on each health insurance plan with the objective of empowering individuals to make informed choices and to facilitate selection of a qualified health plan; and either have or can easily establish relationships with the target population.