Did you know you can get help with enrolling in individual health insurance and seeing if you’re eligible for cheap or free health insurance? One easy way to find free assistance near you is to visit the local help page of Healthcare.gov and enter your city or zip code. This is a safer bet than searching for something like “individual health insurance agents near me” since it will be more comprehensive and specific.
If your state uses the federal marketplace website (Healthcare.gov), you’ll get a list of results showing nearby assisters. If your state has its own enrollment website, you’ll be directed there to see local assisters. You can use filters to narrow down results by assister type, languages spoken, and other factors. There may be more names listed during open enrollment periods than other times of the year.
Read on for more details on types of assisters and things to consider.
Types of Marketplace Assisters
The Affordable Care Act of 2010 (ACA) defined a new role of navigator specifically to help people enroll in individual health plans. It also established grants to community organizations (nonprofits, clinics, etc.) to fund them. The law says navigators should be culturally competent and work to reach uninsured people who are “vulnerable and underserved.”
Over time, due to different funding streams, a few additional positions evolved in some states:
- In-person assisters (IPA), which have roles very similar to navigators.
- Certified application counselors (CACs), which are similar in that they help consumers enroll in insurance. However, they don’t have as many responsibilities as navigators to help consumers before and after enrolling. They may even be trained volunteers who just help local nonprofits during open enrollment periods.
For simplicity, we will call all these types “assisters” since they can all assist you. They can help with applying for individual health insurance and then enrolling in a health plan. But you may see different names for them in some cases.
“Navigators and other assisters perform a valuable service for people who need help with the marketplace website and enrolling in insurance,” says Lisa Duchon, PhD. “I assisted many independent contractors and others who wanted help to understand their options and enroll in a health plan.” Duchon served as a CAC at a nonprofit in Austin, Texas, for five years.
Assisters are in Every State
All states must have consumer assistance programs for the marketplace, but the assister types and numbers may vary. It partially depends on if your state uses Healthcare.gov or has its own marketplace and enrollment website. A few more states started using their own websites in 2022, so there are now 18 state-based marketplaces, with the rest using Healthcare.gov. People from any state can visit Healthcare.gov and they will be re-directed if needed.
All assisters must complete annual state/federal training about the marketplace and eligibility and take a test to get certified. They also must uphold strict privacy standards since they deal with people’s personal information. They cannot recommend one plan over another or deal with issues like billing problems. Assisters just help you fill out the online paperwork and compare and enroll in a health plan.
Assisters cannot accept payments or commissions from insurance companies or insurance agents/brokers so that they remain impartial.
Other Types of Assisters
In all states, health insurance agents and brokers can also provide free help with enrolling in individual insurance. These professionals have been assisting people with insurance since long before the ACA and marketplaces existed. If they enroll people in health plans through the state/federal marketplaces, they must undergo the same training as other assisters.
One difference between them and the nonprofit assisters is that agents/brokers can help people enroll in plans that are outside marketplaces as well as inside. (A plan must be listed in the marketplace for someone to receive subsidies to help pay for it, but other plans are available.) Also, agents/brokers can recommend plans for people’s specific needs, and they usually receive commissions from insurance companies. Agents might not offer as many health plans as brokers do if they only work with certain companies.
Consumers can also ask questions and get free enrollment help by calling the marketplace. In states that use the federal website, there’s a toll-free telephone number that’s open 24/7. States with their own enrollment portals have phone numbers published on their websites.
Open enrollment for individual insurance for 2023 coverage is from November 1, 2022, to January 15, 2023, in most states. This enrollment period differs slightly in a few states, such as Idaho (ends December 15th) and Massachusetts (ends January 23rd). In five other states, open enrollment ends on January 31st. During open enrollment, anyone who qualifies for individual insurance can sign up through the marketplace where they live.
Special Enrollment Periods
If you want to buy individual insurance outside of this timeframe, you will need to qualify for a special enrollment period. You can qualify due to circumstances including getting married, having a baby, moving, losing coverage involuntarily, and other situations.
Note that nonprofit assisters also can determine if you qualify for Medicaid instead of individual insurance and help you enroll. The income levels needed for Medicaid vary depending on if your state has expanded Medicaid eligibility or not. You can enroll in Medicaid any time during the year if you qualify. There aren’t certain enrollment periods for Medicaid as there are with marketplace insurance and most other types of health insurance.
For details on individual insurance and how to choose and use a marketplace plan (even if someone helps you to enroll), see Chapter 5 in Decoding Health Insurance and the Alternatives: Options, Issues, and Tips for Saving Money.
*This article was written by Lauren Jahnke, MPAff, author of Decoding Health Insurance and the Alternatives: Options, Issues, and Tips for Saving Money.