The Critical Ground Game Navigators Pursue Year-Round: Following Up with Consumers and Partners to Ensure Coverage to Care
November 6, 2024 | By Heather Bates, MSW and Sara Hart
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Open Enrollment into quality, affordable health coverage made possible through the Affordable Care Act (ACA) is now under way, and federally-funded Navigators are positioned across community-based organizations and care settings to help individuals and small businesses apply for and enroll in health insurance plans.
However, the work of a Navigator doesn’t stop with Open Enrollment; Navigators have a core responsibility to follow up with those they help to enroll and other community members year-round.
Follow-up builds trust over time and creates the space for critical conversations that may improve the health of communities.
For example, Navigators take time to:
- Provide qualified health plan enrollment assistance made possible through the ACA.
- Support Marketplace appeals processes for HealthCare.gov or State-based Marketplaces.
- Facilitate efforts to resolve data matching and other Marketplace enrollment issues.
- Provide education in culturally and linguistically appropriate ways, meeting individuals where they are (e.g., addressing the digital divide where communities do not have access to reliable internet to enroll in health coverage and access telehealth).
- Ensure that those who have enrolled pay their premiums and understand cost-sharing and the implications of cost-sharing reductions.
- Address access to care questions to help individuals make the most of their coverage and receive essential services.
Navigators Address the Needs of their Communities: Assisting from Coverage to Care
Only half of American adults report understanding health insurance terms. The Department of Health and Human Services defines health insurance literacy as measuring a person’s ability to seek, obtain, and understand health insurance plans, and once enrolled, use their insurance to seek appropriate health care services.
A key responsibility of Navigators in their follow-up work is to enhance health insurance literacy among enrollees by guiding them through the Coverage to Care process.
Navigators are uniquely positioned to cut through the noise and confusion, helping individuals understand costs, coverage details, and important deadlines year-round. They work with community members to take action and meet key deadlines, serving as a central workforce to address health insurance literacy through follow-up efforts. As a result, Navigators are in a key community role between understanding costs and coverage.
Navigators Go Beyond Coverage to Care
In addition to addressing health insurance literacy, many Navigators take steps to address health-related social needs such as food, housing, and benefits, working toward the goals of Healthy People 2030. This initiative aims to improve the health and lives of all Americans by eliminating health disparities, achieving health equity, attaining health literacy, addressing emerging health issues, and setting targets for social determinants of health.
The year-round follow-up strategies that Navigators develop and prioritize are essential to supporting community success in maintaining coverage and ensuring ongoing access to care.
Consistent follow-up allows Navigators to:
- Help individuals meet enrollment deadlines. Enrollment periods are time-sensitive, and timely follow-up addresses issues quickly to avoid coverage gaps.
- Keep up with major life changes that may affect eligibility. People qualify for different types of enrollment opportunities as their lives — and the lives of their families — change and evolve. For example, Medicaid enrollment is ongoing all year, while a Special Enrollment Period occurs due to a change in life circumstances.
- Provide clear and timely information in plain language. Health insurance can be complex, and by instituting a proactive follow-up strategy, Navigators help clarify details about plans, coverage options, and eligibility so people can make informed decisions.
- Ensure all required steps are completed and documentation submitted to maintain coverage. Sometimes enrollments require additional documentation or information, and follow-up ensures that individuals have provided everything needed to finalize their enrollment.
- Demonstrate commitment. Proactive follow-up builds trust and establishes an outreach pathway for years to come, reinforcing that Navigators are dedicated to providing unbiased, impartial, free enrollment assistance — always with no strings attached.
- Keep enrollees informed. Policies and plans may change, but follow-up ensures that Navigators keep people informed with new and timely information. Navigators also have direct access to the Health Insurance Marketplace to get questions answered.
- Build relationships with community organizations. Establishing partnerships with local organizations enables Navigators to guide individuals toward resources that address social determinants of health.
Consistent Navigator follow-up is vital to helping individuals maintain their coverage and stay healthy.
Community engagement by Navigators doesn’t stop at the end of the Open Enrollment Period; it is year-round and ensures access to quality, affordable health care. This ongoing engagement is crucial for supporting individuals and building healthier communities.
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!