What is a Navigator? An individual or entity that conducts community outreach activities to raise public awareness about new health insurance exchange or “marketplace” options and facilitates enrollment of eligible individuals and small businesses into Qualified Health Plans (QHPs) through the health insurance marketplace.
What is required of Navigators? Navigators must have expertise in eligibility, enrollment rules and procedures for Tenncare, CoverKids, and marketplace tax credits, must be capable of facilitating enrollment of Qualified Health Plans, provide fair, accurate and impartial information and be able to provide referrals for grievances.
Who are Navigators in Knoxville? Knoxville Area Project Access (KAPA) is the Knox County and surrounding counties Navigator program.
What is a CAC (Certified Application Counselor) entity? A community based organization, medical provider, or other 501c organization with expertise in social service program that will assist Navigators in educating the public on the health insurance exchange and facilitate enrollment in qualified health plans on the marketplace and for Tenncare and CoverKids.
When does the health insurance exchange take place? Open enrollment for the health insurance exchange takes place November 1, 2015- January 31, 2016. After that point, consumers only can get health coverage for 2016 through a special enrollment period. A special enrollment period occurs if a consumer has a qualifying life event such as move to a new state, change in income, or change in family size.
How will I afford health insurance plans? Premium tax credits and cost-sharing reductions may be available through the Marketplace. Premium tax credits can lower consumers’ monthly premiums right away for enrollment in a qualified health plan (QHP) through the Marketplace. If consumers are eligible, the value of the tax credit may either be paid directly to the health insurance company or given to consumers as a refund at the end of the year when they file their federal income taxes.
To be eligible consumers must:
File federal income taxes annually
Have household incomes of at least 100% but not more than 400% of the federal poverty level
Enroll in a qualified health plan through the Marketplace
Be ineligible for minimum essential coverage through either public programs or their employers
What if I don’t sign up for a qualified health plan and remain uninsured? If consumers decide not to enroll during an open enrollment period, the consumer may have to pay a fee under the individual responsibility requirement. The fee in 2016 is higher than it was in 2015 — 2.5% of household income or $695 per adult, whichever is higher.
How do I reach KAPA to speak with a Navigator?* You can call into KAPA’s office at 531-2766 to request to speak with a Navigator.
How do I get more information regarding the Affordable Care Act?* You can visit www.healthcare.gov or call KAPA at (865) 531-2766.
*Information Updated 1/27/2016
The Open Enrollment period for 2016 coverage is November 1, 2015 to January 31, 2016.
If you haven’t enrolled in coverage by then, you generally can’t buy Marketplace health coverage for 2016 until the next Open Enrollment period for coverage the following year.
If you’re enrolled in a 2015 Marketplace plan, your benefit year ends December 31, 2015. To continue health coverage in 2016, you can renew your current health plan or choose a new health plan through the Marketplace during the 2016 Open Enrollment period.
If you don’t have health coverage during 2016, you may have to pay a fee. The fee in 2016 is higher than it was in 2015 — 2.5% of of household income or $695 per adult, whichever is higher.
During Open Enrollment, if you enroll:
Between the 1st and 15th days of the month, your coverage starts the first day of the next month. Between the 16th and the last day of the month, your coverage starts the first day of the second following month. So if you enroll on January 16, your coverage starts on March 1.
The best way to protect yourself from fraud in the Health Insurance Marketplace is to be informed ---> read more here