Who Best Serves ACA Enrollees with Plan Decisions?

Only about a quarter of the 900,000 working-age Illinois residents who became eligible for insurance through the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) used the federal Marketplace, HealthCare.gov, during the 2014 open enrollment period, according to an analysis of census data by Illinois Health Matters. The Chicago Tribune reported that many of these Illinoisans pursued information about the ACA through regular insurance agents or brokers instead of through federally funded navigators. Florida, on the other hand, experienced the highest rate of health insurance enrollment using HealthCare.gov than any other state during the first month of 2015.

A March 2014 Urban Institute Health Policy Center survey noted that 7 percent of those looking for coverage used or tried to obtain assistance from navigators, application assisters, certified application counselors, or community health workers, and 12 percent used or tried to use assistance from an insurance agent or broker. Further, the survey reported that navigators had been used by more than one in five adults who looked for information in the Marketplace.  The question arises whether ACA enrollees are better off using navigators or insurance agents.


Section 1311 of the ACA requires the federally run Marketplace to make navigators available and authorizes HHS to provide grant funding to assist states to plan and establish their own Marketplaces. A state can use the grant money to plan and administer its navigator program, but navigators cannot be paid by these grants; they are paid through the operational budget of the Marketplace. The navigators complete 30 hours of HHS-approved training, which includes information on qualified health plans (QHPs), insurance options, public outreach activities, Medicaid eligibility, and enrollment processes. Navigators help consumers successfully wind through the Marketplace website and choose the health option that is best for them. Navigators are restricted from asking consumers about specific health issues and from leading consumers to a particular health plan option; thus, there is no financial incentive to steer consumers into higher priced plans. Navigators are specifically trained about the ACA’s coverage options, particularly Medicaid. The disadvantage of using navigators is that consumers must provide personal identity information during the enrollment process, and concerns have been raised in the past regarding navigators’ access to personal information and identity theft.

Insurance Agents

Insurance agents may ask consumers specific questions about their health and are then able to recommend specific plans or insurers that may attend to those health needs. The con, from a consumer point of view, is that insurers pay agents a commission on plans sold (usually a percentage of the premiums), which may incentivize agents and brokers to sell higher-priced plans. Further, insurance agents primarily deal in private health insurance rather than the ins and outs of Medicaid and may not be adequately equipped to help consumers make the right coverage choices.

Is Time Running Out for Navigators?

Whether enrollees use navigators or insurance agents is a personal decision, but the need for navigators may be short-lived. For instance, Kaiser Health News reported that Illinois is spending about $25.8 million in federal funding for more than 900 navigators for the open enrollment period ending February 15, 2015. The expense has motivated Get Covered Illinois, the state’s Health Insurance Exchange, to invest $150,000 to help 13 insurance brokerages pay for co-branded marketing materials, said Jennifer Koehler, Get Covered Illinois’ executive director. The site getcoveredillinois.gov currently lists approximately 150 insurance agents who have completed state training courses in Medicaid and data security. It is possible that in the future, enrollees may not have a choice in who assists them with Marketplace enrollment as other states could expend more money to engage more insurance agents.