Since the Affordable Care Act (ACA) passed in 2013, consumers across the country have had access to affordable health coverage through the Health Insurance Marketplace.
The ACA also established programs to support consumers in taking full advantage of these coverage options. A key example is the Navigator program, which funds organizations in the 28 Federally-facilitated Marketplace states to help consumers and small business apply for and enroll in health insurance plans.
Over the last decade, Navigators have played a critical role in increasing access to our country’s health care system. See a list of the recently awarded 2024-2025 Navigators.
“Navigators have helped educate and enroll millions in quality coverage, contributing to the lowest uninsurance rate in our nation’s history, including record enrollments in communities often left behind.”
– Xavier Becerra, Secretary of the Department of Health and Human Services
What Makes Navigators Unique
Navigator programs are crucial to linking under-resourced populations to health coverage. Focused on connecting with hard-to-reach communities, Navigators engage areas with high uninsured populations that also face multiple barriers related to social determinants of health, including education, employment, and income.
Navigators work to increase both health insurance coverage and health literacy by conducting outreach and consumer education year-round. By using an array of educational tools and applying cultural competency promising practices, Navigators significantly reduced uninsured numbers nationally.
The Role of a Navigator
Navigators play an important role in the national effort to ensure consumers enroll in health coverage. During both Open Enrollment (November 1, 2024 – January 15, 2025) and Special Enrollment Periods throughout the year, Navigators have several key responsibilities:
- Provide information in a culturally and linguistically appropriate manner for populations served.
- Inform people about their new insurance options.
- Conduct public education activities about what enrollment options are available.
- Distribute impartial information about plan enrollment and availability of tax credits.
- Help people enroll in qualified health plans.
- Provide referrals for people with complaints and questions about their health plan.
- Help people keep their coverage and stay enrolled.
Differences between Navigators and Agents/Brokers
Agents and brokers are other types of trained insurance professionals who can help consumers enroll in health coverage.
| Navigators: | Agents/Brokers: |
|---|---|
Do not work for health plans and legally required to remain unbiased. | Work directly for health plans. Agents may work for a single health insurance company, while brokers may represent several companies. |
Don’t charge for their services. | Some agents charge for SEP enrollment assistance, but they rarely charge for OE. |
Provide information on all the plans available in their state and service area. | May only provide information on some plans. |
Have no financial stake in any plans a consumer enrolls in. Their pay does not change based on the plan the consumer chooses. | Receive payment for each enrollment they complete, often receiving bonus income for retention and growth. |
Must provide post-enrollment assistance to consumers, such as resolving data matching issues/inconsistencies, submit ineligibility appeals and requests for resolution of complex cases, and resolving agent/broker fraud. | Are not required to provide any post-enrollment assistance. |
Learn more about how Navigators work with agents and brokers.
Note: Some communities also have certified application counselors (CACs), most commonly found in hospitals and community health centers. Like Navigators, they must complete federal training and remain impartial. However, CACs are not required to assist any resident of their state who walks through their doors or provide enrollment assistance all year.
Locate a Navigator using Find Local Help
- Go to the Find Local Help page on HealthCare.gov.
- Enter the consumer’s zip code in the search field.
- Select the tab for Assisters on the search results page.
- Use the filters to find an assister that best fits the consumer’s needs.
Spread the word about Navigators this fall to help everyone in your community gain access to health coverage.
Transform Health is a nationally certified women and minority led health care consulting firm. Reach out to us today if you would like to work together. Contact Heather Bates, COO, and VP of Stakeholder Engagement at heather@transformhc.com. We would love to hear from you!