So it sounds like agents and brokers might be one type of navigator—provided they aren’t paid by the insurer for a particular enrollment in a qualified health plan—but other types of entities should get navigator grants, too. Does the Affordable Care Act envision other roles for agents and brokers in the exchange?

Yes. According to Section 1312 of the Act, the Secretary will establish procedures under which states may allow agents or brokers to 1) enroll individuals and small employers in qualified health plans, and 2) assist individuals in applying for premium tax credits and cost-sharing reductions in exchanges. Under that section of the law, insurers are not prohibited from paying agents and brokers for their services. While the yet-to-be-issued procedures will clarify how this will work, it appears that agents and brokers can be paid by insurers for enrollments (as they are now) or can be paid a fee by the exchange, but when they are paid by insurers, they cannot simultaneously get grants to act as navigators.


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