Brokers have played a significant role in how health insurance is sold and bought in the U.S. However, with the arrival of the health insurance exchanges, brokers can expect their traditional role to undergo a major change.
Getting Started: Exchanges Create Navigator & Assister Roles for Brokers
The ACA seeks to address a traditional problem that has plagued consumers when buying health insurance plans—understanding what they are purchasing. This is why the ACA mandated a comprehensive SBC (Summary of Benefits and Coverage) for every health plan. This ensures that consumers have access to comprehensive information about every aspect of the proposed coverage. However, consumers often need personalized guidance to understand the intricacies of health coverage. Traditionally producers, i.e. agents and brokers, handled such concerns. The ACA wanted to replicate the producers’ role, albeit make it more accountable and exhaustive. Further, considering that the exchanges will offer a totally new buying experience, first-time consumers are likely to need more assistance. This is why federal mandates insist that state health care exchanges train and recruit customer assistance specialists in the form of Navigators & Assisters.
There is still a role for Brokers in the new health insurance exchange market (we offer Broker Solutions for Florida and some other states) and some may find employment opportunities as navigators or assisters depending upon their experience, qualifications, understanding of the regional healthcare market and relationships with local communities. State authorities are likely to recruit brokers associated with established health insurance organizations like the National Association of Health Underwriters—an association representing nearly 100,000 agents, brokers and health plan specialists from every state in the nation. Most industry analysts believe that brokers have an advantage as they are licensed professionals who understand nuances of the healthcare industry.
Conventional Broker vs Navigator-Assister Roles
Typically, brokers are primarily concerned with selling health insurance whereas navigators and assisters will work toward ensuring consumers’ empowerment by providing detailed, easy-to-understand and accurate information. Navigators & assisters will serve the role of health plan advocates and counselors, helping reach consumers who might not be aware of health insurance options available to them. Federal mandates provide some clarity as to what is expected from navigators and assisters in health insurance exchanges. Some specifics have been left to the states’ decision, i.e. rulings that will be specific to each state health care exchange.
Navigators will be exchange professionals with the primary objective to educate consumers about health plans and provide guidance toward making a wise buying decision. It is interesting to note that to become a navigator, having brokerage experience or certification is not necessary. Navigators are expected to serve as outreach professionals. This will enable the exchanges to reach people who have been traditionally uninsured. As outreach specialists, navigators will be expected to educate ethnic communities about the online marketplace. Understanding that performing the role of a navigator is beyond the realm of a broker’s typical profile, states have been asked to provide proper navigator training and certification facilities.
Navigators will be entrusted to provide fair and impartial information about health insurance and facilitate enrollment. They will be allowed to offer referrals to enrollees apart from forwarding consumer complaints/grievances to the concerned state or federal department. Assisters will perform functions almost similar to a navigators’ profile. However, their primary responsibility will be to deliver enrollment volumes rather than ensuring proper guidance to consumers shopping at the exchanges.
Which profile is likely to be more challenging—Navigator or Assister?
You must have a valid broker’s license to become an Assister, which is likely to draw more interest from registered brokers. Navigators are likely to be pulled from community organizations and non-profit entities. Navigator-like entities can also be formed by unions, professional organizations, small business development units and chambers of commerce.
Federal mandates insist that navigators interact with community-based organizations to facilitate more exchange-based enrollment. There are discussions to create community-specific navigators who would dedicatedly represent a certain section of the population. Candidates proficient in non-English languages might be preferred since they can better communicate with ethnic communities.
Navigators need to understand the dynamics of non-exchange enrollment processes too such as Medicaid, CHIP, Medicare and SHIP (State Health Insurance Assistance Program).It is possible that specializations might arise within the navigator pool employed at state health care exchanges. For instance, some navigators might specialize in distributing outreach information, some might take leadership roles such as arranging community meetings and others could take care of the online application/enrollment process. These dynamics of the navigators’ functioning will become clear only when the exchanges start operating.
In the follow-up to this discussion, we talk about challenges common to navigators & assisters, misconceptions about brokers working in the exchanges and the role of web brokers in the era of online marketplaces.