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The Important Role Played By The Health Care Navigator



By Beryl Dalton


As the Affordable Care Act continues to be implemented, many consumers are still struggling to navigate the new system and locate the right coverage to properly insure themselves. For some, this can be a frustrating experience as they try to comply with the law's requirements. For all of those people, a health care navigator can provide invaluable assistance.

In fact, these navigators were considered a crucial part of the new law when its details were being drawn up. Lawmakers recognized that many citizens would not have the experience or knowledge required to navigate the insurance market. To counter that, the law created a system of guides who could assist newcomers to the market as they began to search for the policies they now need to comply with the stringent requirements imposed by the Act.

As this law currently stands, navigators have several key duties that must be carried out. First and foremost among those duties is their obligation to provide the public with information about the availability of medical coverage plans that meet the requirements set out by the Act. At the same time, they are charged with facilitating consumer enrollment in plans that meet those requirements.

To accomplish those goals, the guides must provide critical information to the communities they serve. This involves helping to match consumers to the policies that best serve their needs. It also involves helping citizens to calculate the government assistance they may be eligible for in the form of subsidies. And, of course, all of this communication should be delivered while being sensitive to the language used by the community and its unique culture.

There are times when these helpers are unable to assist their customers with aid packages or enrollment concerns. At such times, the navigation program requires that consumers be directed to various government offices or private assistance. In most cases, such referrals end up with consumer assistance or an ombudsman. These agencies and officials are uniquely qualified to deal with a variety of problems and complaints.

The law details a variety of individual and group types that can qualify as navigators. These include various community non-profit organizations, trade and professional associations, local chambers of commerce, and unions. Licensed insurers can also qualify under certain circumstances, though strict guidelines are in place to prevent any agents from profiting from these policy acquisitions.

The government has established rules governing the exact details regarding who can qualify for these positions. In addition, there are specific criteria in place for determining which of these guides can qualify for grant money associated with enrollment activities. In principle, these requirements are designed to ensure that no conflicts of interest arise as the various communities are served by local navigators.

As there continues to be many discussion about the Affordable Care Act, and many controversies surround its implementation, one thing is certain. The role of these critical navigators is of the utmost importance. The inability of large numbers of people to successfully navigate this process on their own is not going to end any time soon. The good news is that because of the important work done by these guides, those people can receive the assistance they need to sign up for the policies mandated by law.




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