Sept. 20, 2013 -- Oct. 1 will bring the opening of health insurance Marketplaces in every state, where people can buy coverage to begin in 2014.
Most Americans won't need to do anything because they have health insurance through their employer or the government. But people who do use the Marketplaces are likely to find them complicated at best and bewildering at worst.
Standing by will be thousands of paid and unpaid helpers to guide you through the process. Some work for the Marketplaces and some do not.
1. What kind of help is available?
There will be four types of helpers available:
- Navigators, who work for the Marketplaces. They will teach you about the Marketplaces and help you enroll. Navigators will be available in all states.
- In-person assisters, who are similar to navigators.
- Certified application counselors, who will help you enroll for health coverage through the Marketplaces. They work for hospitals or nonprofit groups.
- Agents and brokers. The rules for them are different in each state.
2. What does the navigator program do?
The navigator program helps anyone who wants to get insurance through a Marketplace. The goal of navigators is to help “consumers understand the basics of insurance, how it works, and how they enroll in the Marketplace," says Elizabeth Calhoun. She is a professor of health policy and administration at the University of Illinois at Chicago. "They'll help people digest information so they can make the best decisions."
Navigators will be required to take 20 hours of training. They must be impartial and are not allowed to recommend specific plans.
3. Why should I get help from a navigator?
Anyone can visit a Marketplace and buy coverage on their own. But it is complicated, and help from navigators is expected to make a big difference.
For example, some Americans will need help figuring out whether to take a federal subsidy (financial aid) when they pay their premiums or later as a rebate when they file their taxes, says David Adler. He is a program officer at the Robert Wood Johnson Foundation who monitors health insurance issues.
Family relationships can create confusion, too. For example, he says, a couple with children from another marriage may need help to figure out eligibility for coverage.
Calhoun says the navigators can also get the word out about how many people -- like families of four making less than $94,200 -- are eligible for financial aid.
4. What other kinds of helpers will be available?
Other helpers include in-person assisters and certified application counselors, who are available only in certain states.
In-person assisters are similar to navigators. The difference is their jobs are funded differently from navigators.
Certified application counselors work for community health centers, hospitals, nonprofits like churches and labor unions, and non-federal government agencies. They will help you understand, apply, and enroll for health coverage through the Marketplace. They must complete 5 hours of training and comply with privacy laws and other standards.