Many people shopping for health coverage on the public exchanges established under the health care overhaul law will need some help navigating these new marketplaces. With enrollment starting next month, it's important to get the most comprehensive, objective assistance.
Consumers will have access to online, telephone and face-to-face assistance. Many of the helping hands will be certified by the exchanges and trained to give individuals impartial help in comparing plan features, determining eligibility for financial assistance and completing applications. People should know "they can go to someone who doesn't have an interest in getting them in any particular program or plan," says Julie Silas, senior attorney at Consumers Union.
That's important because consumers are also likely to get offers of help from companies that aren't certified and may not inform customers of all their plan options. Some may be insurance companies marketing their own products.
Con artists also are getting in on the act, posing as enrollment agents while trying to extract personal information, according to the Federal Trade Commission and some state insurance departments. Enrollment doesn't begin until October 1, and anyone who claims to be able to enroll you sooner is a scammer, the FTC warns. Likewise, be wary of callers using the new law as a hook to ask for a Social Security, Medicare or bank account number. And some rogue Web sites have been posing as official state health exchange sites.
Navigating the New Marketplace
To find legitimate sources of information, start with the federal government's Healthcare.gov or contact the national call center at 800-318-2596. If your state is running its own exchange, this site will provide a link to the state marketplace Web site. When the exchanges are up and running, all of the marketplace sites should provide a list of helpers who have been certified to assist consumers.
Among these certified helping hands are "navigators," who must complete a training program, provide information on all health-plan options and avoid conflicts of interest—such as compensation from insurance companies. Many will be from nonprofit groups.
With the federal government selecting navigators late this summer, however, these helpers have just a few weeks to get up to speed on the complexities of the new marketplace. And in many states, navigators will be operating on a shoestring budget—and consumer advocates fear there won't be enough of them. Thirteen of the 34 states where the U.S. government is helping to run the exchange will get just $600,000 each. In a state such as Kansas, with more than 300,000 uninsured people under age 65, the $600,000 it's receiving won't go far, says Tricia Brooks, research assistant professor at Georgetown University Health Policy Institute.
"Certified application counselors" will help fill in the gaps. These individuals may include staff members of community health centers, hospitals and other health care providers. Like navigators, they'll be certified and required to complete training. Unlike navigators, they're allowed to have certain conflicts of interest as long as they disclose them. A staffer at a hospital that gets the best reimbursement rates from Plan XYZ, for example, can help you enroll but must disclose the financial relationship with the plan.
Insurance companies generally cannot get certified but may set up services to help consumers enroll. Given the limited budgets for certified assisters in some states, "it may be that the marketing message will be louder from private insurers," says Karen Pollitz, senior fellow at the Kaiser Family Foundation. Insurance brokers and agents, who are typically paid by insurers for enrolling people in their plans, can also help consumers sign up on the exchanges.
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