What is a Health Plan Navigator?

August 20, 2013 Audrey Dalton

The Current ACA Challenges

The Affordable Care Act and the epic healthcare reform changes are not yet entirely understood and continue to experience ongoing changes to the provisions–even with open enrollment right around the corner starting October 1st!

Tax preparers, for instance, the people who must explain to their clients when they require insurance, and how much it will cost, are jamming into continuing education classes in record numbers. Once there, they find out that the regulations are incomplete, still being written, and often, that the regulations have changed this month from last month. Employer mandates, for instance, have been postponed until 2015.

Health Plan Navigators to the Rescue?

Insurance agents are concerned that they stand to lose clients and commissions under the navigator program and consumers may be adversely insured due to inappropriate advice.1

Although these concerns might be valid at first glance, a closer look clearly states that navigators will not sell or solicit insurance plans; however, they will help consumers compare plans and make informed decisions as well as guide them through the enrollment process. Additionally, the majority of people coming to the state or federal marketplaces will be newly insured, may not speak English nor will be health insurance literate. This is where the navigator and non-navigator assisters can help.

“Understanding health insurance coverage is hard enough: navigators and assisters will also be required to explain it to people who may not speak English and who have never had health insurance.”2

As the role of “navigator” comes into focus, people at all levels of the healthcare process will rely upon this spokesperson to perform the role of guide and counselor. In addition, the navigator will be charged with selling the concept so that participation in the system is high enough to fund it.

An alternative way exchanges can reduce costs and guide new members throughout the enrollment process is to hire a “virtual health navigator” or in other words a CodeBaby Intelligent Virtual Assistant. It’s a virtual benefits advisor, who

can consistently communicate the regulations, and discuss plans, coverage levels, and premiums with prospective members–without the need for ongoing training. It can be programmed to speak any language and if necessary get extra help via email, chat, or a phone call. The demo here shows you how the virtual assistant can be just as effective explaining why someone would choose coverage, in this case she speaks of critical illness coverage, available on a private exchange.

Find out more about our Benefits Advisor Solution today.

1Health Affairs Blog, “Implementing Health Reform: Proposed Regulations for Exchange “Navigators”, http://healthaffairs.org/blog/2013/04/04/implementing-health-reform-proposed-regulations-for-exchange-navigators/

 2Behavioral Healthcare, “Navigators to play key role in Obamacare health insurance enrollment” http://www.behavioral.net/article/navigators-play-key-role-obamacare-health-insurance-enrollment?page=2

About the Author

Audrey Dalton

Audrey holds nearly 10 years of B2B/B2C sales, marketing, and communications experience. She manages the content strategy and development for multimedia campaigns and digital marketing programs at CodeBaby. She also has wistful aspirations to be a globetrotting mega DJ.

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