Consumer Assistance Programs

For immediate answers to your questions, call the new 24/7 help line: 1-800-318-2596. Or go to www.healthcare.gov for live chat and all other inquiries. The help line and the website will also help consumers find the navigators and other assistors described below.

What are consumer assistance programs?

Starting on October 1, 2013, consumers in all states will be able to purchase and enroll in health insurance through the Health Insurance Marketplaces. To assist people with enrollment and to answer questions, the federal government and state governments will work with individuals to train them to become market place counselors and navigators.

Who will be trained to assist with the enrollment?

Navigators – funded through state and federal grants to receive comprehensive training, these individuals will help customers use the electronic health insurance marketplaces, as well as with submitting applications via mail, in person, or over the phone. These navigators will assist people in establishing eligibility to enroll through the marketplace, and help determine if they are qualified to receive the premium tax credit (link to premium tax credit page), cost sharing reductions, Medicaid or the Children’s Health Insurance Program. All navigators will provide fair, balanced and unbiased information about all insurance plans available to consumers.

Non-Navigators – These individuals are also known as “in-person assistance personnel.” The non-navigator will serve the same roles as a navigator in helping people enroll the health insurance marketplace. These individuals will serve through a state optional program that the state can set up before the Marketplace is economically self-sustainable, and BEFORE the navigator program is fully operational.

Certified application counselors – Each federally funded marketplace will designate organizations and ask them to certify some of their employees as application counselors. Counselors will educate consumers and assist them in completing online applications. To become a designated organization, an online application must be submitted. Types of organizations can include community health centers, other health care providers, social service agencies, or hospitals. If you or your affiliated organization would like more information on how and when to become certified, please visit: http://marketplace.cms.gov/.

Agents and Brokers – When all marketplace requirements have been met by state, licensed health insurance agents and brokers will be allowed enroll small and large employers and their employees along with individuals. The agents and brokers will be compensated for their services through either the health insurance company or consumer, and these individuals must go through comprehensive training and certification requirements set by the state and federal government.

What if a person needs more help making decisions?

For people with disabilities, the elderly, or anyone who may need assistance in navigating and enrolling in the health insurance marketplace, an authorized representative can be established to provide help. An authorized representative can be anyone that an individual chooses including family members, service providers, an established legal guardian, or a person with power of attorney over an individual will also be recognized as authorized representatives. This authorized representative will be able to enroll the designated consumer in the health insurance marketplace, and help ensure that they receive the proper coverage and benefits. Individuals can change their authorized representative at any time.

What kind of assistance will be available through the Marketplace?

 NavigatorsNon-Navigator assistance personnelCertified application counselorsAgents and brokers
State-based marketplace Yes Optional for states Yes Optional for states
State Partnership Marketplace Yes Yes Yes Yes, if a state permits it
Federally facilitated Marketplace Yes Not applicable; Navigators provide this assistance Yes Yes, if a state permits it

*www.cms.gov

For any additional information and more resources about what your state is doing, please visit: https://www.healthcare.gov/what-is-the-marketplace-in-my-state/