Will Navigators Replace Brokers Under Obamacare?


ConversationSince the Patients Protection and Affordable Care Act, a.k.a. Obamacare, was passed in March, 2010, that question has been one that has worried and concerned health insurance agents across America.

Congress stated that there must be a role for insurance brokers.  However, the law is pretty vague about what that role would be.  Congress left that up to the Secretary of Health and Human Services and she has not shown much concern about employees of the insurance industry over the past 3 years.

When the law was first signed by the President, many health insurance agents stopped working with health insurance.  They either elected to leave the insurance industry totally or change specialties.

I must admit that while I have kept up with the implementation of Obamacare for those under 65, I have concentrated more on insurance planning for people during retirement for the past 3 years.

Until a couple of weeks ago, I was not certain that there would be a future for insurance brokers like me who want to help people before they retire.

Approximately 60% of Americans get their health insurance through their employers.  That is wonderful for them!  However, it also means that approximately 40% of Americans are responsible for their own health insurance.

Many of them elect not to pay for health insurance.  Over the past 5 years we have heard much about the “poor uninsured.”

However, there is another group that will be affected by Obamacare.  That is the middle-class Americans who do not get health insurance benefits from their employer but elect to pay premiums for an individual policy out of their income.

Both the “poor uninsured” and middle class Americans who do not have group health insurance are asking, “Will navigators replace brokers under Obamacare?”

In this post I want to try to explain what the difference between them will be and which you should contact if you need help in October.  I will stand by the information below only for Federally Facilitated Exchanges.  If you live in a state that has set up its own health insurance exchange, the information below may, or may not, be accurate.

NAVIGATORS

Although Navigators are supposed to be available to help all Americans, their primary purpose and training, is to identify and help the “poor uninsured” with the systems that will be in place to assure that they get health insurance and take advantage of any government programs to which they are entitled.

Navigators will receive 20-30 hours of on-line training.  They are not to be licensed or regulated by any state agency, other than the new health insurance exchanges.

In theory, they are to be unbiased sources of information.  Navigators are not supposed to offer any insurance information beyond explaining what the coverage is that is being offered by companies on the exchanges.

However, if a Navigator does offer insurance related information and it proves to be unsatisfactory, they are exempt from prosecution.

Since Navigators are limited to helping people with the new health insurance exchanges, they are not able to help you get plans that are offered outside of the exchanges.  That includes both supplements to help pay for what the Essential Benefit Plans do not pay and Major Medical plans that are offered by insurance companies who elect to offer health insurance in a state but do not want to deal with an extra layer of government regulations that are required for plans that participate in the exchanges.

BROKERS

Although insurance brokers are authorized to help all Americans apply through the new health insurance exchanges, (That means that you can get both help from your insurance broker and a government subsidy if you qualify) their main role will be to help middle-class Americans, who do not get health insurance at work, build and obtain the health insurance portfolio that they need.

Unlike Navigators, insurance brokers who have completed the Department of Health and Human Services certification, will have access to both the new health insurance exchange and plans that are sold outside of the exchange.

Be careful.  Not all insurance brokers will have access to the new health insurance exchanges.  That ability is only granted to those who have certified with the Department of Health and Human Services.

Good insurance brokers will also be able to help you identify areas where the government approved “Essential Benefit Plans” are inadequate for your needs.  They will be able to help you identify and use supplemental plans to customize a portfolio to your unique insurance needs.

The result is that if you already have an insurance broker whom you trust, you should still be able to consult with him/her.  The only caveat is that if you plan to claim the tax-credit subsidy, make certain that your insurance agent has completed certification training for the new health insurance exchanges.

The tax subsidies are limited.  If you are going to claim a premium subsidy, you must apply for the second least expensive “Silver” plan through one of the new health insurance exchanges.

 

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