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Navigators and their Role in Health Insurance Exchanges

Yes, consumers like online comparison, but buying health plans is more complex and invariably requires experts' assistance. Recent survey conducted in the State of Colorado revealed the importance of 'Navigators' in an Insurance Exchange. The study highlighted that people preferred a non-biased opinion/ suggestion/ guidance from the Navigators while choosing a health plan. And, in case they are eligible for State plans, they want Navigators to guide them to those relevant programs. These conclusions validate the importance of Navigators in building an effective exchange.

Until the concept of Exchange gets familiar, a majority of consumers will prefer live assistance. Thus, to build an effective exchange, we believe States should factor in the following elements to strengthen Navigators role -

  • Exchange portal for navigator functions that allows Navigators to work on behalf of the user
  • Compliance to HIPPA and Gramm-Leach-Bliley-Act (GLBA) in handling PHI and information sharing
  • Robust training/ product awareness program for Navigators
  • Transparent and well defined Navigator certification process
  • Navigator performance tracking & management
  • Incentives and payment mechanisms for Navigators
  • High Navigator availability - in real-time

There is often a question if the term Navigators can be interchangeably used for Brokers. Brokers have always been a part of the Health insurance industry and act as a liaison to create product awareness and enroll members. For long, Brokers have done a good job of representing the health insurers and representing the employers in negotiating a better plan. In the context of exchange, States are still examining the goals of a broker and the kind of guidelines they need to be subjected to, especially when it comes to State programs - Medicaid, CHIP and subsidy programs etc.

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