Counselors get ready to help people pick health plans

As the Tuesday opening of online health-insurance exchanges creeps closer, those who will help advise people through the process -- called navigators and certified application counselors -- are finishing their training and getting certifications.

The Affordable Care Act requires every American to have health-care coverage in 2014 or pay a tax penalty. Those whose employer does not pay for health insurance or are ineligible for Medicare or Medicaid will have to enroll in a health insurance plan using online health-insurance exchanges.

Navigators, supported by taxpayer dollars and licensed by the state, will help those who need assistance in enrolling in health insurance via the exchange.

Two groups in Missouri received navigator grants in federally facilitated and state partnership marketplaces. Primaris Healthcare Business Solutions, a federal health services contractor, was awarded $1,045,624, and the Missouri Alliance of Area Agencies on Aging, which provides services for the elderly, was awarded $750,000, according to the Centers for Medicare and Medicaid Services.

The main difference between a navigator and a certified application counselor is funding, said Jeremy Milarsky, navigator and program manager at Primaris in Columbia, Mo. Unlike navigators, CACs are not funded by the federal government.

Dave Dillon, vice president of media relations for the Missouri Hospital Association, said individual CAC training that is a condition of employment at hospitals is paid for by the employer, but he could not say for certain that was the case for CAC training at other organizations.

While navigators must have 20 hours of training and participate in outreach and education, CACs are required to have only five hours of training, Milarsky said. However, if a CAC is funded by the Missouri Foundation for Health, "an independent philanthropic foundation dedicated to improving the health of the uninsured and underserved in the region," according to its website, they also must have 20 hours of training and participate in outreach and education. Both navigators and CACs can enroll individuals in a health-insurance policy from the exchange, he said.

To be a navigator or CAC, individuals must be affiliated with a health-care or not-for-profit organization, have experience with protecting people's privacy and security and must prevent conflicts of interest, he said.

The state sees navigators and CACs the same -- both conduct one-on-one counseling and assistance in the use of health-care exchanges, Milarsky said. Navigators and CACs must be certified by the government and licensed by the state, along with their organizations, he said.

Insurance companies are not allowed to be navigators or CACs, Milarsky said. Insurance agents or brokers can help with the exchange, but those individuals are not obligated to be unbiased.

"This program is about unbiased counseling -- it's about giving people information," he said.

Charley Tinsley of the Thomas Insurance Group in Cape Girardeau said he believes the exchange will be a good thing for local health-insurance agents. Agents will have more people purchasing health insurance, and the change will "weed out" agents who are close to retirement or not serving their clients, he said.

Ultimately, the exchange will bring more clients and less competition between agents, which he said is better for the client in the long run because there will be more competent health-insurance agents.

Tinsley is not concerned with the competition navigators may bring, citing the private information that will be shared between navigators and those using the exchange when trying to qualify for a subsidy.

"I don't know how many people are going to be willing to do that with an agent versus a navigator," he said.

As the world of insurance changes, Tinsley said he does not see agents being eliminated.

Primaris joined 11 other Missouri communities to offer its services because "we all know our own communities best," Milarsky said. Primaris and its partners will cover key cities including Cape Girardeau, Columbia, St. Louis, St. Joseph, Clayton and West Plains. The Agencies on Aging will cover all of Missouri except Kansas City.

"Those gaps, we hope, will be filled by CAC organizations," he said.

APS Navigator of Southeast Missouri State University is a partner of Primaris and was given $68,000 of the grant money, Milarsky said.

The program will provide navigator services to Cape Girardeau, Perry, Scott and Bollinger counties, said Jean Gooden, director of APPLE and APPLE Paperwork Service Navigator.

APPLE is a paperwork service for people age 60 and older, and the navigator program will go through APS Navigator. The initial grant for APPLE was written by a Southeast professor, and the university still oversees the program, Gooden said.

Gooden said she has three staff members working on their individual certification through the Center for Consumer Information and Insurance Oversight, which falls under the Centers for Medicare and Medicaid Services. The training consists of 26 modules, with a test after each module, she said.

Gooden hopes three navigators from APS Navigator will be enough, but she said CACs also will help fill the gaps.

APS Navigator will be ready for Tuesday, she said, adding there is enough time to inform those who need to know about the program by the last day of the enrollment period, March 31.

Glenda Hoffmeister, executive director of Southeast Missouri Area Agency on Aging, said 10 agencies of the Missouri Alliance of Area Agencies on Aging agreed to participate in the navigator program, including the local office.

The purpose of navigators is to provide education to the uninsured and assist them through the exchange process, notify them of other benefits they may qualify for and enroll them in a policy they can afford, she said.

Hoffmeister said local navigators from the Agencies on Aging will focus on outreach and education for low-income areas, small businesses and those who may need help understanding English. Examples of outreach and education include presentations and seminars, she said.

Hoffmeister said three of her staff members have passed the navigator training and testing, and by the end of September she will have four. The staff members are waiting for their licenses from the Missouri Department of Insurance. After spending most of September getting organized for Tuesday, Hoffmeister said the navigators will be ready.

"There's a lot of background that's being done right now to be up and ready and to go," Hoffmeister said.

To contact APS Navigator, call 290-5272. To contact the local Agency on Aging office, call 335-3331.

adowning@semissourian.com

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Pertinent addresses:

1925 William St., Cape Girardeau, MO

937 Broadway, Suite 202, Cape Girardeau, MO

1219 N. Kingshighway, Suite 100, Cape Girardeau, MO