Next Step in Implementation: Finalizing policies to ensure Navigators will help consumers enroll in the Health Insurance Marketplace

The Centers for Medicare & Medicaid Services (CMS) took the next step in moving toward implementation by finalizing a proposed rule today outlining the standards for Navigators, the in-person assisters in Federally-facilitated and State Partnership Marketplaces. State-based Marketplaces have the option of using this guidance or developing their own. The rule identifies training, conflict of interest standards, and standards for serving people with limited English proficiency and people with disabilities.

Navigators and similar in-person assisters will provide unbiased information to consumers about health insurance, the new Health Insurance Marketplaces, qualified health plans, and public programs including Medicaid and the Children’s Health Insurance Program.

“If individuals request assistance and would like in-person assistance, navigators will be available nationwide when the marketplace opens. Navigators will be trained to play a vital role in fulfilling our commitment to help consumers learn about and apply for quality health insurance when open enrollment for consumers in the Marketplaces begins October 1,” said CMS Administrator Marilyn Tavenner.

CMS will ensure that all consumers who need Marketplace customer service can receive it from trained professionals. Millions of Americans will be eligible for new coverage opportunities through the Marketplaces beginning January 2014. Navigators will provide accurate and impartial assistance to consumers shopping for coverage in the new Marketplace, including consumers who are not familiar with health insurance, have limited English proficiency, or are living with a disability. Grant awards for Navigators in states with Federally-facilitated and State Partnership Marketplaces will be awarded on August 15, 2013.
In addition to Navigators, Marketplace consumers will have access to assistance through services such as a call center, where consumers can receive help with the eligibility and enrollment process. The call center will also provide referrals to the appropriate state or federal agencies, or other assistance programs including in-person assistance personnel, certified applicationcounselors, and agents and brokers. The final rule also outlines the standards for certified application counselors, including training, qualifications, and requirements to ensure that they provide quality, sound, consumer-protective assistance.

In addition to English and Spanish, the call center provides assistance in more than 150 languages through an interpretation and translation service. Customer service representatives are available for assistance via a toll-free number at 1-800-318-2596 and hearing impaired callers using TTY/TDD technology can dial 1-855-889-4325 for assistance.

Open enrollment in the Marketplace begins Oct. 1, 2013, with coverage to begin Jan. 1, 2014.
To learn more about helping consumers apply and enroll in health coverage through the Marketplace, visit: http://www.cms.gov/CCIIO/Resources/Files/Downloads/marketplace-ways-to-help.pdf . To access the final rule released today, visit: http://www.ofr.gov/inspection.aspx