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Patient navigators


Patient navigators educate and assist United States citizens in enrolling into health benefit plans stipulated in the Patient Protection and Affordable Care Act (ACA). Patient navigators are also called “insurance navigators” or “in-person assisters” who have defined roles under the ACA. Although their roles might overlap, patient navigators are not community health workers or health advocates. “Navigators” work in states with Federally-Facilitated Exchanges (FFEs) or State Partnership Exchanges.

Under the ACA, a health insurance marketplace, or exchange, is required to develop and fund a patient navigator program. The patient navigator’s primary role, as defined in section 1311, is to educate the public on information about health care plans, to facilitate enrollment into health plans, and provide information for tax credits and cost-sharing reductions. The education and information provided by patient navigators must be culturally and linguistically appropriate and provided in a fair and impartial manner. Patient navigators are required to meet standards and core proficiencies established by the Secretary of Health and Human Services.

Prior to certification and training, the Centers for Medicare and Medicaid Services (CMS) require that all navigator and non-navigator individuals or entities seeking to facilitate public enrollment in plans disclose information that may result in a conflict of interest to exchanges and consumers. This information includes:

If a navigator or non-navigator does have a conflict of interest while serving in their respective roles, they are to provide a plan for mitigating these conflicts. Failure to submit a mitigation plan will result in the inability to serve as a navigator and promote ACA health plan benefits.

The ACA requires that all navigator and non-navigator personnel and entities be certified by the Federally-Facilitated Exchange or State Partnership Exchange through which they are funded. Certification is provided upon completion of a training program approved by the U.S. Department of Health and Human Services (HHS).

Navigators and non-navigators must first register with their exchange prior to completing a training program and qualifying for certification. Certification entails:


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