Beware Of Tricky Navigators

Rat ThiefOn October 1 the National Open Enrollment begins for people who are required to buy their own health insurance.  On that date, baring some sort of injunction from the courts, delay from the White House or miracle in congress, the new health insurance exchanges will begin operation in all 50 states.

The Obama Administration calculates that it will be necessary to enroll 10,000,000 healthy Latinos in the new health insurance exchanges in order to keep premiums as low as they are anticipated.  Advertising efforts and navigators have specifically targeted Spanish-speaking citizens.  Although their efforts are legitimate, be careful.  Copycats will target Hispanics as well.

The Navigators are forbidden by law to give any advice about what insurance option people should buy.  However, last week I read that some “Navigator” organizations are already gearing up to help people choose which plan to get.

The roll of the Navigator is supposed to be limited to helping people “navigate” the new health insurance exchanges.  They are neither licensed nor qualified to give advice on insurance products.

Frankly, I do not understand the double standard that is in our nation.  When MO attempted to require Navigators to get a license in order to help people with insurance questions, there was a loud national uproar.  However, when the head of a hospital blatantly says that Navigators are needed to help people choose “which plan should I get,” there is silence.

Although the new health insurance exchanges are “lightning rods” for politically motivated complaints, they are the only option to process enrollment and payment of all the government health insurance programs.

My concern is not about the legitimacy of the health insurance exchange system; at least not for this post.  My concern is that there will be some Navigators, who are trained properly, who will be tempted to answer insurance related questions when they have no training or background in insurance.

According to the PPACA and Department of Health and Human Services, Navigators are supposed to limit their advice to technical matters dealing with the new health insurance exchanges.  They are neither trained, nor qualified, to give advice about “what option should I choose.”

Ideally, you will know, before you start your application, which health insurance plan you want.  If you do, there is absolutely no reason not to call a Navigator to help you with the computer navigation.

However, with 26 years of experience in health insurance, I know that the ideal happens only rarely.  When someone calls a professional for help, they are often so confused that they ask for recommendations rather than decide on a plan for themselves.

That is one reason I prefer to have a smaller agency.  I have learned that when I tell my clients what plan to get, when something goes wrong, I get blamed.  Since I abhor customer service problems, I feel comfortable sharing my opinion when I am asked but I insist that my clients decide for themselves what plan they want.


Licensed health insurance agents are answerable to not only the client, but also to state Departments of Insurance and insurance companies.  If we continually give bad advice, not only can we lose our contract but we can be fined.

Navigators are not accountable to any regulatory agency.  Other than losing their temporary job, they are not held accountable for anything they say.

Navigators are only required to undergo 30 hours of HHS training before they interact with the public.  One House member put it like this last week.  “The same person who cut your grass last week can advise you on health insurance through the health insurance exchanges.”


You do not have to boycott the new health insurance exchanges or avoid Navigators.   The health insurance exchanges are the only place you can go to get a tax-credit.  The Navigators are a legitimate option to help you if you are not comfortable on the computer.

However, to prevent potential fraud, make your own plan choices.  Don’t rely on an untrained, inexperienced individual to give you insurance advice.  If you need professional help making your decision, call a licensed health insurance agent.

Your health insurance agent is trained to review all your insurance and make certain that the option you elect coordinates with your other plans.  He will help you identify what is covered and what is not.

Navigators who give insurance advice are restricted to telling you, “the Bronze plan is the least expensive but in order to get a tax-credit you must elect the Silver plan.”  Any insurance advice they give you beyond that is beyond the scope of their job-description.


When the National Open Enrollment starts on October 1, you will have two options from which you may buy government approved health insurance, if you are responsible to get your own health insurance.

If you need professional help with the application you will need to call the trained professional who can help you best with the marketplace you choose.

1.  Government Exchanges

The politicians and press are talking like the new exchanges will be your only option.

The PPACA authorizes the creation of self-sustaining, internet based health insurance “exchanges.”   However, the Obama administration did not like the term, “exchange.”  In May, they changed the terminology to “marketplace.”

While the name change may be more understandable, it implies that the new exchanges are your only option.  It is a political trick.

If you want to claim a government subsidy or enroll in a government program, the new health insurance exchanges are your only option.  You should use one of the following trained professionals if you have any problems.

  1. Call Centers
  2. Navigators
  3. CMS Certified Insurance Brokers
  4. In-Person Assistors

2.  Out-Of-Exchanges

There will be a second “marketplace” available for those who do not want to claim a government “subsidy” or enroll in a government program, like Medicaid or CHIP.

The PPACA authorizes insurance companies to sell government approved health insurance policies outside of the exchanges.  If that is what you elect to do but need professional help, you can contact the following.

  1. Call the insurance company directly
  2. Call your local, licensed health insurance broker

To be technical, there is something called a, “private exchange” but they are few and far between.  Most private exchanges, at least at this time in history, deal with options for group health insurance.

Alternatives 2