In-Person Assistance in the Health Insurance Marketplaces

In-Person Assistance in the Health Insurance Marketplaces

Background

Starting October 1, 2013, consumers in all states were able to access affordable health insurance options through the Health Insurance Marketplace. Some states set up a State-based Marketplace and the remaining states opted for the Federally-facilitated Marketplace (FFM).

No matter what state they live in, consumers can receive help as the apply for and enroll in coverage through the Marketplace.

Open Enrollment for the 2025 plan year begins November 1, 2024 and individuals will again be able to provide assistance to consumers in a number of different ways: by becoming Navigators or certified application counselors. In addition, agents and brokers will still be able to help consumers enroll in health insurance through the Marketplace.

Key Resources

Navigators

Each year, the Centers for Medicare & Medicaid Services (CMS) makes grant awards to organizations who serve as Navigators in FFM states. Navigators play a vital role in helping consumers prepare applications to establish eligibility and enroll in coverage through the Marketplaces and potentially qualify for an insurance affordability programs. They also provide outreach and education to raise awareness about the Marketplace, and refer consumers to health insurance ombudsman and consumer assistance programs when necessary. Navigators operate year-round—increasing awareness among the remaining uninsured about the coverage options available to them, helping consumers find affordable coverage that meets their needs, and assisting consumers beyond the enrollment process to ensure they're equipped with the tools and resources needed to utilize and maintain their health coverage all year. Navigators must complete comprehensive federal Navigator training, criminal background checks, and state training and registration (when applicable), prior to assisting consumers.

On August 26, 2024, CMS awarded $100 million in Navigator cooperative agreement awards to 44 organizations who will serve as Navigator awardees in the 28 states with a FFM. These awards support the work of organizations that offer assistance to consumers navigating, shopping for, and enrolling in health insurance coverage for plan year 2025.

A list of 2024 Navigator grant recipients can be found here: 2024 Navigator Grant Recipients. (PDF) The 2024 Navigator awards are for the first 12-month budget period of the five-year period of performance, which began August 27, 2024 and runs through August 26, 2029. Entities and individuals cannot serve as Navigators in FFMs without receiving federal grant funding from CMS to perform Navigator duties.

Additional Resources for Navigator Applicants

Archived Resources for Navigator Grantees

Navigator Grant Recipients

Certified Application Counselors (CACs)

Certified application counselor designated organizations (CDOs) are a vital component of the assister community. In the Federally-facilitated Marketplaces (FFMs), CDOs oversee certified application counselors (CACs) who are trained and able to help consumers seeking health insurance coverage options through an FFM. Organizations that wish to become CDOs designated by the Centers for Medicare & Medicaid Services (CMS) to serve in an FFM must submit an online application and enter into an agreement with CMS. These groups might include community health centers or other health care providers, hospitals, or social service agencies.

Additional Resources for CACs

Enrollment Assistance Personnel (EAP) Program

The Centers for Medicare & Medicaid Services (CMS) has implemented a multi-pronged approach to improve Medicaid coverage transitions, including a ramped-up direct outreach effort to streamline the consumer experience. CMS has reestablished and revamped the Enrollment Assistance Personnel (EAP) program, with EAPs helping consumers navigate coverage transitions from Medicaid into Qualified Health Plans (QHPs) through the Federally-facilitated Marketplace (FFM). EAPs operate under a contracted assistance model under which Cognosante LLC has been retained to conduct direct assister-to-consumer outreach alongside Navigator grantees in all 28 FFM states, beginning in September 2024, to help consumers maintain continuity of coverage.

Through ongoing training and resources, EAPs are prepared to help consumers who lose Medicaid coverage to facilitate a seamless transition to Marketplace coverage. CMS is also ensuring the EAPs' efforts are coordinated with other assisters in the community to help consumers understand basic concepts and rights related to health coverage, provide enrollment assistance, and work with individuals to link coverage to care. EAPs will maintain a critical presence in each of the FFM states. To schedule an appointment with an EAP in your state, please use one of the state-specific scheduling links below or contact them at (877) 864-4370.

Book an Appointment with an EAP

If you have any EAP related questions, please contact us at EAPQuestions@cms.hhs.gov

Additional Resources for Consumers Seeking EAP Assistance

Agents and Brokers

Agents and brokers also play a key role in the Health Insurance Marketplace. To the extent permitted by states, agents and brokers play an important role in educating consumers about Marketplaces and insurance affordability programs, and helping consumers receive eligibility determinations, apply for premium tax credits and cost-sharing reductions, compare plans, and enroll in coverage. In particular, agents and brokers play a critical role in helping qualified employers and employees enroll in coverage through the Small Business Health Options Program (SHOP). Consumers may want to obtain professional advice from agents and brokers when applying for and selecting a qualified health plan. Below is a link to the CMS webpage for agents and brokers choosing to participate in Federally-facilitated Marketplaces.

Additional Resources for Agents and Brokers

 

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Page Last Modified:
10/31/2024 09:31 AM
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