Health Care Reform: Recent News & Events

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The Health and Human Services Department (HHS) on Wednesday outlined the standards for "navigators" who will help consumers shop for health insurance in new marketplaces created by the Affordable Care Act.

The healthcare law establishes insurance exchanges in each state, where consumers who don't get insurance through their employer can compare and buy plans.

The law also provides a role for navigators — similar to traditional insurance agents and brokers — to help consumers understand their options.

Navigators cannot be paid by insurance companies, and they do not have to be licensed as agents or brokers. The healthcare law says each exchange must have two entities certified as navigators, one of which must be a nonprofit.

Navigators cannot select a plan for their clients and are not in charge of determining whether customers are eligible for federal subsidies, HHS said in a proposed regulation Wednesday.

"That said, Navigators may play an important role in facilitating a consumer’s enrollment in a QHP [qualified health plan] by providing fair, impartial, and accurate information that assists consumers with submitting the eligibility application, clarifying the distinctions among QHPs, and helping qualified individuals make informed decisions during the health plan selection process," the rule states.

Exchanges themselves will handle eligibility determinations, and the exchanges are also intended to have a strong customer-service component, including call centers and physical offices.

Navigators will provide extra assistance to people who are disabled, do not speak English or "who are not familiar with health insurance," HHS said.