Saturday, February 7, 2015

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.

Under the current version of this law, there are a number of duties resting on the shoulders of the navigators. The chief obligation involves the dissemination of information about the Act and the medical plans that fulfill that law's basic mandates. They are also given the responsibility of making the enrollment process as convenient and easy as possible.

This entails the distribution of information to all who need it. This information is supposed to include details about the types of plans that currently qualify, as well the various types of credits and financial assistance that can be found in the various exchanges. In addition, all of the information must be presented in a manner comporting with the language and cultural needs of the relevant community.

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.

There are several different types of people or associations that can serve in this role. Non-profits in the community are eligible, as are unions and various trade groups. The local chamber of commerce can even provide this service, as can insurance agents if they adhere to the law's dictates. Those requirements are there so that agents cannot profit in an unethical manner.

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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