Individuals considering a job as a health insurance navigator should familiarize themselves with the Affordable Care Act, which can be accessed through the U.S. Department of Health and Human Services Web site (https://www.hhs.gov). Familiarity with insurance terms and options may be gained by taking courses in insurance or interning at an insurance company, while an understanding of the different needs of consumers from diverse socioeconomic and cultural backgrounds, or for whom English may be a second language, may be obtained by volunteering with community agencies. Individuals considering become a health insurance navigator may wish to review resources offered by the Centers for Medicare and Medicaid Services, which detail their obligations, duties, and manner in which their tasks are to be performed. Some navigator positions are available at nonprofit agencies, but volunteers are nevertheless subject to training and certification requirements.
Health care insurance navigators are part educator, part adviser, and part facilitator. By law, their primary function is to provide public education about qualified health plans in the health insurance marketplace. This is generally facilitated by agencies (termed “navigator entities”) which apply for and are awarded federal grants to fulfill the intent of the ACA and employ the individual navigators. The ACA obligates the navigator to act in the unbiased, best interests of the consumer, and not any insurer. Though the navigators must have knowledge of the insurance industry and products, they are considered separate and distinct from insurance agents and brokers, who have vested interests in guiding consumers to certain products or plans.
Navigators meet with individuals or small business representatives to provide information about available health insurance plans offered by the marketplace, both private insurance plans and public benefits (such as Medicaid and low-cost family or child health plans offered by some states) including information and comparisons about benefits, costs, tax credits, and enrollment. The navigator must have the ability to present the information to the population being served and therefore must be skilled and sensitive to language and cultural differences among consumers. After providing relevant information which allows a consumer to make an educated choice about a specific health insurance plan, the navigator assists with the enrollment process and the completion of paperwork or online forms.
Navigators also refer consumers to appropriate resources to address problems and grievances. By law, there can be no costs or fees assessed to any consumers for the assistance of a navigator. Navigators are held to strict ethical standards with respect to confidentiality, avoidance of conflicts of interest, and lack of bias.