Tuesday, July 16, 2013

CMS Releases Guidance on Marketplace Navigators

As the Affordable Care Act progresses, health insurance marketplaces are set to open for citizens in all states in two and half months. Last week, the Centers for Medicaid and Medicare Services (CMS) released the final rule that outlines the training and duties of a marketplace “navigator.” You can read more about the navigators in the May NAHAM New article “Healthcare Assisters verses Navigators.”

In short, the navigators will be charged with providing expert advice on a wide range of issues to people signing up for insurance coverage under the health law. According to CQ, the rule requires navigators in the federally run marketplaces to go through 30 hours of training before they can start helping consumers. The rule also outlines standards for certified application counselors, who will also help people with their questions about how to get coverage. Navigators and certified application counselors will be providing help in the 33 states that will be served by the federal insurance exchange or that will be partnering with that exchange. The remaining 17 states are setting up their own such marketplaces and will provide help, at least initially, through what are known as “in-person assisters.”

Navigators, certified application counselors, and in-person assisters must be knowledgeable about qualified health plans, insurance affordability programs, tax implications of enrollment decisions, eligibility for premium tax credits and cost-sharing reductions, and other topics.

The states running their own exchanges can establish their own, more rigorous qualifications and requirements is they choose. 

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