Those who assist with health plan enrollment now have expanded roles – are they prepared?

About Joanne Kenen

Contributing editor to Politico Magazine and former health care editor-at-large, Politico, Commonwealth Fund journalist in residence and assistant lecturer at Johns Hopkins Bloomberg School of Public Health.

Photo: Carol Von Canon via Flickr

One clear lesson that health law advocates have drawn during the first two enrollment seasons under the Affordable Care Act is that many, many people need help sorting through their health plan choices as they try to enroll.

Among the many ways to get that assistance is by consulting a government-funded navigator or in-person assister (IPA), who must have training in the health law and enrollment procedures.

Health Affairs recently published an issue brief that reviews these services. The brief looked at who these service providers are, where they operate and how their role has broadened from helping people learn the basics about costs and subsidies and then helping them enroll. Navigators and IPAs now also help comparison shop plans during re-enrollment periods, and further educate people on how to use their health insurance wisely to get proper care without running up unnecessary bills. But while their job has expanded into providing more “health insurance literacy,” the Health Affairs article notes that training in how provide these additional services might not have expanded adequately:

People who have trouble with the online Marketplace or need more assistance with their individual situation can turn to navigators and IPAs (in person assisters) to walk them through the eligibility and enrollment process. Navigators are individuals or community-based organizations funded by federal or state grants to help guide consumers in the Marketplace, assist with subsidy applications, and enroll in a health plan. IPAs perform many of the same functions as navigators, but they are funded through separate grants or contracts.

A third category of enrollment assisters, certified application counselors, help people fill out applications and compare health plans but perform more limited functions than navigators and IPAs. Since the first open enrollment period, navigators’ and IPAs’ roles have evolved to include reenrollment efforts, educating consumers on how to use their insurance, and addressing post-enrollment questions and problems. Not only is the consumer-assistance process time- and resource-intensive, but navigators and assisters do not necessarily have the expertise to address some of the new issues they are facing.

We also know that the level of available consumer assistance varies from state to state. Generally speaking, the states running their own marketplaces tend to do a better job than those relying solely on the federal exchange.

The brief explains the program in detail, but here are some story ideas you could pursue this enrollment season:

  • Are there more, or less, assistance resources in your state than in past years? How is the word getting out?
  • Did your state put any restrictions on the role of insurance agents and brokers – and are those professionals now pushing back? How have brokers changed their approach to the ACA and outreach? How knowledgeable and helpful are they about Medicaid expansion and eligibility?
  • What new tools are outreach groups using this year to connect people with assistance as they enroll or re-enroll? How has it changed, since outreach now is focusing on people who shunned the ACA – or never realized they were eligible – during the first two years?
  • Given that assisters are now being asked questions and confronting problems faced by the newly insured beyond the initial scope of their training, have they received additional training? Have states developed systems (as suggested in the Health Affairs brief) that create a core group of more specialized assisters to can handle referrals about complex problems?

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