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Where do consumers go for help to choose and enroll in a plan?


Consumers should make a list of questions before they shop for a health plan. Consumers should gather information about household income and set a budget for health insurance. Consumers should find out if they can stay with their current doctors and pharmacy, and understand how insurance works – including getting an understanding of deductibles, out-of-pocket maximums and copayments.

There are a number of other resources from the Kaiser Family Foundation, Consumer Reports, the National Association of Insurance Commissioners, and the U.S. Department of Health and Human Services and the Department of Labor to help consumers understand how insurance works, the different insurance options, and what to consider when you buy coverage.

A new standard form called the Summary of Benefits and Coverage (SBC), and the companion Uniform Glossary that includes a set of uniform definitions, are also available for all health insurance plans. This information can help consumers compare different insurance options. Consumers can get the form and definitions through the Health Insurance Marketplace or ask the plan for it.

If a consumer is eligible to buy coverage through the Health Insurance Marketplace, he or she can enroll through a link on doi.nebraska.gov, the Marketplace website at HealthCare.gov, by phone at 800-318-2596, or in person through agents, navigators or certified application counselors. More information on these programs is found elsewhere on this website.

There are three types of individuals trained to help consumers make decisions about health coverage.

Insurance agents

Health insurance agents sell insurance coverage on behalf of one or more insurance companies. Health insurance agents are licensed by Nebraska and receive continuing education related to their job. They can help educate consumers about health insurance policies, help consumers apply for coverage, and advise consumers about the type of health insurance coverage that best suits them and their family. Agents can sell consumers insurance plans in the market outside the exchange, as they always have.

Agents who want to sell policies through the Health Insurance Marketplace will have had extra training from the U.S. Department of Health and Human Services (HHS). They will have passed a test at the end of their training to sell insurance policies through the Health Insurance Marketplace. Consumers may wish to talk with more than one agent before making a decision on which plan to buy.

Navigators

Navigators are individuals trained to help consumers understand the insurance policies available through the Health Insurance Marketplace and answer consumer questions about the Marketplace as well as insurance affordability programs, including Medicaid and CHIP. Navigators also can help educate consumers about their health insurance policy options and help them apply for coverage. Navigators get grants from the federal government and receive training on how to assist consumers. After training, they must pass a test and be certified by the federal government. Contact information for navigators can be found elsewhere on this website.

Certified application counselors

Certified application counselors are to provide enrollment assistance to consumers. Certified application counselors receive and successfully complete comprehensive training. They, too, can help educate consumers about health insurance plans and help them complete an application for coverage. Examples of application counselors include staff at local community health centers, hospitals or other consumer non-profit organizations.

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