How to Navigate the Medicaid and Marketplace Enrollment Maze

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How do you find your way through the mountain of forms and complex procedures of Medicaid and/or the Marketplace?  You find a Navigator.  Navigators have been around for awhile but recently, with the Affordable Care Act, their jobs have been redefined.  What Hoosiers need to know is that there are two types of Navigators: Federal and Indiana.

So what’s the Difference between the two?

The difference is how they’re selected, trained, monitored, and funded. Both types of Navigators assist consumers with enrolling in coverage, including Medicaid, at the Health Insurance Marketplace.   This web-based tool is sometimes called the “Marketplace” or “exchange.”  The Marketplace is a new way to find quality health coverage.  It can help if you don’t have coverage now or if you have it but want to look at other options.

With the Marketplace, you can learn if you can get lower costs based on your income, compare your coverage options side-by-side, and enroll in coverage.

A Federal Navigator working in Indiana must complete Indiana Navigator certification in addition to any federal certification requirements. Federal Navigators will also be subject to Indiana Navigator monitoring and regulation practices.

Indiana Navigators must complete the Indiana Navigator application and training process, and abide by the Indiana Navigator laws and regulations passed by the State of Indiana, as well as the federal Patient Protection and Affordable Care Act.

What does this mean to me?

Aspire provides its own Navigators, called Entitlement Specialists, for all consumers who want and need assistance.  Before the Affordable Care Act, our Entitlement Specialists assisted our consumers only with enrollment in Medicaid services, but since becoming certified Indiana Navigators, our Entitlement Specialists can also fully assist our consumers in Medicaid and Marketplace enrollment.  This means that our Entitlement Specialists can assist individuals with questions and applications for healthcare services, such as Medicaid, insurers through the Marketplace, or healthcare brokers.

If an Aspire Entitlement Specialist is, or becomes the authorized Medicaid representative for one of our consumers, they can also troubleshoot on behalf of the consumer.

There are some things that Aspire Entitlement Specialists cannot do:

They cannot signup individuals for any benefits other than Medicaid or Marketplace healthcare products, nor can they guide a consumer to a specific healthcare product.  They also cannot provide information for other entitlements such as Social Security, HUD, etc., but the Entitlement Specialist will have contact information for these services.

How do I know if I need/qualify for Entitlement Specialist “Navigator” Services?

You qualify for Aspire Entitlement Specialist services if you’re an Individual who is receiving services through Aspire Indiana, AND:

  • who does not have any type of healthcare insurance and/or are experiencing issues with finding healthcare
  • you need assistance applying or re-applying for Medicaid
  • you are experiencing difficulty with Medicaid services

If you need an Entitlement Specialist “Navigator” or have any questions, you can contact us at our local Aspire office or toll free at (877) 574-1254.

About the author: Tina Skeel is the Director of Vocational Services for Aspire Indiana.  While the beliefs and opinions expressed in this blog are solely those of Ms. Skeel, you can learn more about Aspire’s Vocational Services at https://www.facebook.com/AspireVocationalServices.  You can also follow Ms. Skeel on Twitter @skeelts1.

Photo credit: digitalart via freedigitalphotos.net

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