ACA Update: Who’s Who Among ACA Assisters

By Emily McKinley, Health Information Specialist

The countdown to the full implementation of the Patient Protection and Affordable Care Act (ACA) is in full swing. Yet, there are still many questions lingering among health care organizations and consumers. One is, who can help me purchase the right plan? The legislation addressed this in a not so tidy fashion. That is to say, in an effort to provide assistance to consumers, multiple types of “assisters” have been created. Here’s your Who’s Who Among ACA Assisters rundown:

·         Navigators are ACA assisters who are funded by grant money. Indiana’s Navigators will be funded with federal dollars but will have to complete training and be certified by both the federal government and the state. Navigators will be the most extensively trained assisters in Indiana. They will provide outreach and education as well as assistance to consumers as they shop and apply for insurance coverage. Navigators must remain unbiased and may not have relationships or accept any sort of compensation from insurance companies as result of their activities in this role. In other words, Navigators may only provide education about the plan costs and benefits but may not suggest purchasing any one particular plan. Navigators will also be able to provide information to consumers regarding tax credits, cost sharing subsidies, consumer assistance and ombudsman programs, and other applicable topics. Navigators must be able to provide information in a culturally and linguistically appropriate manner to all consumers, including those with special health care needs.  

·         Certified Application Counselors (CACs) are ACA assisters who are employed by designated Application Organizations. Most often, CACs will be accessible at community health centers and clinics as well as other social service organizations. CACs will be allowed to perform many of the functions of the Navigators but will not have as extensive training. Unlike Navigators, CACs are permitted to have relationships with insurance companies as long as they disclose those relationships to consumers. CACs are also able to make suggestions regarding specific plan purchase.

·         Insurance agents and brokers are individuals who sell health insurance coverage. They are licensed by the state and have completed minimal federal training. These individuals are typically compensated by insurance companies and/or consumers. In other words, they receive commissions for selling particular products to consumers and are not required to present all coverage options available.

·         Champions for Coverage are assister organizations that are available to provide consumer assistance in the form of general Marketplace information and education as well as by directing individuals to local Application Organizations and enrollment centers. Family Voices Indiana plans to serve as a Champion for Coverage organization.

Beginning in September, consumers will be able to find Navigators and other assisters by visitingwww.Healthcare.gov or calling the Help Center at 1-800-318-2596.

Bottom line: When you shop for insurance, be a savvy consumer. Ask the assisters who you interface with whether they have an assister certification and what, if any, relationships they maintain with insurers. It is also important to know if the assister is receiving compensation from an insurer. Move forward with an assister only if you are comfortable with the disclosure and type of assistance offered.

For more information about the ACA or to receive assistance from Family Voices Indiana, please contact us at info@fvindiana.org or 317-944-8982, or visit our website: www.fvindiana.org.