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What’s the Difference Between Health Insurance Agent, Assister and Navigator?

If you’ve heard news and media reports about Covered California, you might have heard some of the buzzwords floating around including agent, assister, and navigator. With the changing landscape of health insurance, many consumers are questioning how they will obtain coverage and what aspects of the insurance marketplace will be different come January 2014.

Benefits of the Exchange Opportunity

All of the people mentioned above could play a role in the enrollment of a health insurance program through the health insurance exchange. The ultimate goal across the state is to increase the numbers of people covered by health insurance and to provide assistance throughout the process. Ultimately, this maximizes the experience for citizens, since they will be able to choose a plan that suits their unique needs after fully evaluating their options.

Roles of Those Assistance

Some of the tasks performed by people in these roles including helping people enroll in their chosen health plan, matching family needs to eligibility for plan selection, educating consumers about the law and the available benefits, and referrals to consumer assistance programs for those customers that may benefit from this.

California’s Enrollment Assisters

The Covered California Assisters Program has two different kinds of enrollment assisters: in person assisters and navigators. For the most part, navigators will be partnered with community-based organizations. Navigators will come from community nonprofits, chambers of commerce, unions, and trade associations. California’s health insurance exchange is known as Covered California. For the purposes of the state, navigators and assisters are basically the same thing. Both are required to be affiliated with an Assister Enrolment Entity and they each serve essentially the same roles. The primary difference is in how they are paid- assisters are compensated with $58 as a flat fee for every successful application (and $25 per annual renewal) and navigators are instead paid on a performance basis by blocks to meet the enrollment targets set by the state.

Working With an Agent

There’s also a big opportunity for life insurance agents in this industry. As individuals are searching for their health insurance coverage, there are options to select “Find a Pro” that will direct that individual towards a local health insurance agent. Agent biographies and websites will be listed, allowing consumers to select to work with someone in their local region. Health insurance agents will also assist in the process of choosing your health insurance plan, and the primary difference is that agents will receive 100% of the commission from the policy sales they make (which is a different compensation structure). Regardless of the option you choose, there are many qualified experts to help guide you through the process of selecting your health insurance coverage.

Some advantages of working with agents are:

1. More resources- They know people at insurance companies to help with issues.
2. Agents help people with resolving claims.
3. Agents are more experienced to suggest a right plan based on clients situations.
4. Agents help clients with the complicated application process.
5. Mostly Agents are local and can meet clients in person.

 

Market Segment

Agents

Assisters

Navigators

SHOP Exchange for small business with 2 to 49 full time employees

X

Individual Exchange

X

X

X

Medi-Cal/CHIP (Formerly Healthy Families)

X

X

X

Private Market outside of CA Health Exchange

X

 

Agents

Assisters

Navigators

How assistance get pay

insurance company pays commission by percentage

$58 per approved application. $25 per annual renewal

Paid on performance basis by blocks of business

Premium difference if purchase via

Same

Same

Same