Navigators and CAPs link New York Health Insurance Plans to Consumers

The Affordable Care Act (ACA) aims to make health insurance available to every American. Because of this, states are mandated to set up their own health care exchange. If not, the federal government will set up the exchange for them. Health insurance exchanges will allow residents to clearly see their health insurance options through a user-friendly marketplace online. Through exchanges, small business owners could easily look for coverage for their employees and apply for tax credits.

New York estimates that the exchange could cover 1.2 million more residents who are now uninsured. Under the health care reform, Americans should enroll in a medical and insurance policy or pay a fee if they choose to go uninsured. However getting people to enroll is not that easy. Providing New York health insurance plans does not finish the job. It takes massive effort to lead people towards enrollment.

The Affordable Care Act has created two programs for the purpose of giving ample information about the health insurance plans available for them and assist them in the enrollment. One program is the Navigator Program which will act like health insurance brokers and serve as information resource and will facilitate enrollment into private or government-funded health insurance plans. For a group to be a Navigator, they must meet the qualifications set by the Affordable Care Act. Navigators are not allowed to receive compensation from insurance carriers for enrollment.

The other program, CAPs (Consumer Assistance Programs) also serves to provide information and to assist with more complex matters regarding the plans in the health care exchange. CAPs are responsible for helping consumers with the enrollment process; educate consumers regarding their rights and responsibilities; recording consumers’ problems and complaints about the plans; and resolving consumer problems and appeals. It appears that some of the tasks of the two programs overlap. The difference in their function are yet to be clarified.

The NY State Health report has released a study that can put a distinction on the two programs’ functions and offer suggestions on how each program can improve their function. Their first suggestion is to merge the two programs into 1 group when carrying functions that are similar to both such as providing information regarding the plans. The report also suggested an administration set up where there should be one central hub that would coordinate the necessary medical care to ensure consistency in medical and insurance services.