Training Overview
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Training Overview
Course Introduction
Training Overview, this communication was printed, published, or produced and disseminated at U.S. taxpayer
expense.
Welcome
Hi! Welcome to the Training Overview course!
I'm Romain, and I'll be helping you learn the answers to these questions and more throughout the course.
• Do you know which training courses your assister type must take?
• Are there differences among various consumer assistance entities?
• Do you know some of the most important questions to ask when helping consumers?
Disclaimers
You need to be aware of these training disclaimers. These disclaimers apply to every course in the training.
Assister Training Content:
The information provided in this training isn’t intended to take the place of the statutes, regulations, and formal
policy guidance that it’s based upon. This training summarizes current policy and operations as of the date it was
uploaded to the Marketplace Learning Management System (MLMS). Links to certain source documents have
been provided for your reference. We encourage you to refer to the applicable statutes, regulations, and other
interpretive materials for complete and current information.
This training includes references and links to nongovernmental third-party websites. The Centers for Medicare &
Medicaid Services (CMS) offers these links for informational purposes only, and inclusion of these websites
shouldn’t be construed as an endorsement of any third-party organization's programs or activities.
Coronavirus (COVID-19):
This training doesn’t address COVID-19-related guidance or related requirements for assisters. CMS will
communicate applicable information to assisters and assister organizations through separate channels.
• To learn more about how we're responding to coronavirus, visit HealthCare.gov/coronavirus.
• For preventive practices and applicable state/local guidance, visit CDC.gov/coronavirus.
Section 1557 of the Affordable Care Act (ACA):
Section 1557 of the ACA is a nondiscrimination provision that prohibits discrimination based on disability, race,
color, national origin (including limited English proficiency), sex (including sexual orientation and gender identity),
and age in covered programs and activities.
As of May 10, 2021, the Department of Health and Human Services (HHS) will interpret and enforce Section
1557’s prohibition on discrimination on the basis of sex to include: (1) discrimination on the basis of sexual
orientation; and (2) discrimination on the basis of gender identity, consistent with Title IX of the Education
Amendments of 1972 and the Supreme Court’s decision in Bostock v. Clayton County, GA (140 S.Ct 1731
(2020)). A court has set aside HHS’s inclusion of sexual orientation and gender identity under Section 1557, as
applied to certain healthcare providers. That decision is on appeal by the agency. See Neese v. Becerra, 2:21-
CV-163-Z (N.D. Tex.), appeal pending No. 23-10078 (5th Cir.). Please consult with counsel if you have questions
on whether a healthcare provider is covered by the decision.
On August 4, 2022, HHS issued a Notice of Proposed Rulemaking on Section 1557 to revise the 2020 Final Rule
by proposing to reinstate robust regulatory protections from discrimination on the basis of race, color, national
origin (including limited English proficiency), sex (including sexual orientation and gender identity), age, or
disability in covered health programs and activities.
Definitions
In this course, the terms "you" and "assister" refer to the following types of assisters:
Navigators in Federally-facilitated Marketplaces
Certified application counselors (CACs) in Federally-facilitated Marketplaces
Note: In some cases, "you" is also used to refer to a consumer, but it should be clear when this is the intended
meaning.
In this training:
• The terms "Federally-facilitated Marketplace" and "FFM" include Federally-facilitated Marketplaces where
the state performs plan management functions.
• The terms "Marketplace" or "Marketplaces," standing alone, often (but not always) refer to FFMs.
• The term “ACA” refers to the Affordable Care Act as amended by the Health Care and Education
Reconciliation Act of 2010.
• The term “disability” is defined by the HHS Office for Civil Rights (OCR) Final Rule (Final Rule)
implementing Section 1557 of the ACA (45 CFR Part 92) as "a physical or mental impairment which
substantially limits one or more major life activities of such individual; a record of such an impairment; or is
regarded as having such an impairment."
Course Goal
Among other duties, you're responsible for providing fair, accurate, and impartial information that helps
consumers identify and compare their coverage options and select the coverage that best fits their budgets and
specific needs.
The FFM assister curriculum consists of courses that prepare you to be an assister, including courses that
prepare you to help consumers who are interested in finding out about their health coverage options through the
FFMs. You must successfully complete all required training courses and exams to be certified. You must be
certified before you can begin your role as an assister, which includes performing any education or outreach
activities.
Goal:
This course will:
• Familiarize you with the format and features of the certification training courses; and
• Introduce the types of consumer assistance entities as well as how these entities can provide fair,
accurate, and impartial information.
Topics:
This course includes information on:
• Navigation, format, and features of training courses
• Certification requirements for consumer assistance entities
• Available learning resources
• Key terminology used throughout this training
• Consumer assistance entity roles and responsibilities
• Consumer support options
• How to describe the FFMs
• Tips for working effectively with consumers
• How to help consumers find the coverage they need
• Consumer referrals
Module 2- Federally-facilitated Marketplace Assister Training Overview
Welcome
This module presents an overview of the Federally-facilitated Marketplace (FFM) training and certification
program for Navigators and Certified Application Counselors (CACs) in FFMs. By the end of this module, you
should be able to understand the following topics and accomplish the tasks below them.
Course Features
Describe the navigation, format, and features of the courses in this training program
Certification Requirements
State the certification requirements for consumer assistance entities
Key Terms
Understand key terms used throughout the training
Introduction
This training applies to Navigators and CACs in the FFMs. These two assister types are referred to throughout
this training as "assisters," "you," or "consumer assistance entities."
Some of the information discussed may also be relevant to Navigators and CACs in State-based Marketplaces
(SBMs), but this training is addressed only to assisters in FFMs.
The terms "Federally-facilitated Marketplace" and "FFM," as used in these training courses, include FFMs where
the state performs plan management functions. Generally, unless otherwise indicated, the term "Marketplace" is
also used in this course to refer to the individual market FFMs but doesn’t include SBMs that may use the
HealthCare.gov platform.
Certification Requirements
The training and certification requirements for assisters in the FFMs are summarized here and in the next pages.
As part of the standards for certification, you must complete the Centers for Medicare & Medicaid Services (CMS)
requirements for your assister type.
Navigators must:
• Complete all required Department of Health & Human Services (HHS)- approved training courses,
including any applicable continuing and recertification education courses
• Pass all required certification or recertification exams at the end of each course intended for Navigators
• Comply with:
o All regulatory requirements specific to your assister type, including conflict-of-interest requirements
o FFM privacy and security standards
o The terms and conditions of your (or your organization's) HHS grant award
CACs must:
• Complete all HHS–approved training courses required for CACs
• Pass all required certification exams at the end of each course intended for CACs
• Meet any licensing, certification, or other standards prescribed by your state, if applicable
• Enter into an agreement with your affiliated CAC designated organization (CDO) (CDOs in FFMs must
enter into an agreement with CMS in its role as operator of the FFMs)
• Comply with the terms of your agreement with your affiliated CDO
Certification Requirements (Continue)
This training program focuses on two of the previously listed requirements: completing required training and
passing required certification exams at the end of each course.
• Your certification after successful completion of this training will be valid until October 31, 2024. Returning
assisters must complete this training by October 31, 2023, to continue functioning as an assister. If
returning assisters do not complete this training by October 31, 2023, they will be decertified and will need
to be issued a new ID to complete this training.
• If you’re affiliated with an assister organization that has its assister designation, grant, or contract
withdrawn, you may not continue functioning as an assister affiliated with the organization, and your
certification as an assister affiliated with that organization will no longer be valid, even if it has not yet
expired.
• You may not hold yourself out as an FFM assister or perform services as an FFM assister unless you’re
affiliated with a current FFM assister organization and have a current certification that accurately reflects
that affiliation or are yourself certified as a current FFM Navigator grantee.
More information about FFM training requirements is included in your organization's Navigator grant award terms
and conditions, your contract or agreement with the Marketplaces, or your agreement with a CDO, as applicable.
When an organization agrees to become a CDO in a state with an FFM, each staff member and volunteer it
certifies as a CAC must enter into an agreement with the organization that requires the staff member or volunteer
to comply with CAC requirements in CMS regulations and guidance.
Training Program
The training program includes multiple courses that provide approximately 5–20 hours of training, depending on
how many optional courses you complete in addition to the required courses. You must complete all required
courses and pass a certification exam at the end of each required course. These courses prepare you for the
exams and teach you how to help consumers understand the coverage options available to them through the
FFMs.
The courses are designed to be taken in order; however, you may complete them in any order you choose. Each
course should be completed before you begin the next one. Optional courses and exams may be included, and
we strongly recommend that you complete these as well.
Training Format
Each course in this training program includes several modules. Information about the courses and modules is
covered on the following pages.
• This training is web-based and self-guided. You can take this training at your own pace, and you can
access the material at any time of the day. You can take the training all at once, or you can take a few
hours of training a day until you complete all required courses.
• This training doesn’t contain audio. You don’t need speakers, a headset, or volume settings to view this
training unless you’re using assistive technology for accessibility.
Course List
Here are the lists of required and optional courses for Navigators and CACs in the FFMs:
New Navigators & CACs in FFMs Required:
1. Training Overview
2. Health Coverage Basics
3. Affordable Care Act (ACA) Basics
4. Privacy, Security, and Fraud Prevention Standards
5. Marketplace Application Essentials
6. Serving Vulnerable and Underserved Populations
7. Cultural Competence and Language Assistance
8. Working with Consumers with Disabilities
Optional:
9. Customer Service Standards and Community Outreach
10. Coverage to Care Assistance
11. Complex Application Issues
Returning Navigators & CACs in FFMs Required:
1. Training Overview
4. Privacy, Security, and Fraud Prevention Standards
5. Marketplace Application Essentials
6. Serving Vulnerable and Underserved Populations
7. Cultural Competence and Language Assistance
8. Working with Consumers with Disabilities
11. Complex Application Issues
Optional:
2. Health Coverage Basics
3. Affordable Care Act Basics
9. Customer Service Standards and Community Outreach
10. Coverage to Care Assistance
Knowledge Checks and Certification Exams
Knowledge Checks
Each course includes Knowledge Checks, which are practice exercises to help you prepare for the exam at the
end of the course. Your score on these practice questions won't be recorded.
Exam
• After completing each course, you're required to take a course exam. You must score 80 percent or
higher to pass each exam. Once you've started an exam, you must complete it in one sitting. If you need
to stop and return to it later, your progress won't be saved, and you'll need to start it from the beginning.
• If you don't pass an exam the first time, you can retake it. If you're unable to pass the exam after two
attempts, we recommend that you review the course before you attempt to complete the exam again. If
you would like to move on to the next course and return to the exam later, you may do so.
Completion Screenshot
After you successfully complete all required courses and exams in the training curriculum, a completion screen
appears. We strongly recommend that you document your successful completion of the training by saving a
screenshot of the completion screen. These screenshots can help the technical team properly record your
progress so you do not have to repeat courses if you have issues with course completions not being recorded.
Training Program Resources
• Resources are available to you throughout this training, including key references, job aids, and helpful
links.
o You can access a complete list of resources for each course by selecting the Resources button at
the top of each screen.
o You may wish to download, print, and save resources for future reference so you can provide the
best possible assistance to consumers.
• After you have completed this training and received your certificate, you may continue to access each
training course and its Resources section whenever you have a question or need to refresh your learning.
• Additional assister resources are available at Marketplace.cms.gov.
Marketplace Information by State: 2023
Select your state in the map to view important characteristics about your state's Marketplace. We encourage you
to write down your state's information to use as a reference, but you can view this map at any time by selecting
the Map button at the top of each screen.
Key Terms Used Throughout This Training
Some basic terms are used throughout the training.
Consumers
In this training, the term consumers refers to:
• Individuals and families who may get coverage through the individual market FFMs.
• Small employers who can offer coverage to qualified employees, former employees, and dependents of
employees or former employees through a Federally-facilitated Small Business Health Options Program
(FF-SHOP) Marketplace.
Consumer Assistance Entities
In this training, the term consumer assistance entities refers to Navigators and CACs in FFMs. Generally, these
are individuals or organizations that are trained and certified to help consumers as they explore coverage options
through the Marketplaces.
Agents and Brokers
Agents and brokers are persons or entities licensed by a state to sell, solicit, or negotiate insurance. To the
extent permitted under state law, agents and brokers may register with an FFM to facilitate enrollment and assist
consumers with applying for qualified health plans (QHPs) and insurance affordability programs (i.e., premium tax
credits (PTCs) and cost-sharing reductions (CSRs)) through the FFMs.
Facilitate Enrollment
To facilitate enrollment means assisting consumers with submitting their eligibility applications, clarifying
distinctions among coverage options, and helping eligible consumers make informed decisions during the
coverage selection process.
Marketplaces
The Marketplaces, including FFMs where the state performs plan management functions, are resources where
individuals and families can:
• Learn about coverage options;
• Find out if they qualify for programs to lower their coverage costs;
• Compare health plans based on costs, benefits, and other important features;
• Choose a health plan; and
• Enroll in coverage.
The SHOP website is a resource where small employers in states with an FF-SHOP Marketplace or SBM using the
federal SHOP platform can:
• Learn about the benefits of SHOP, including the availability of tax credits for qualified employers;
• Compare available medical and dental plans side by side using the SHOP See Plans and Prices tool; and
• Submit SHOP employer applications and obtain final eligibility determinations.
Throughout this training, the term "SHOP Marketplace" or "SHOP" will be used when referring specifically to an
FF-SHOP Marketplace. In the FF-SHOP Marketplaces, qualified employers and employees can enroll in SHOP
plans by working with a QHP issuer or SHOP-registered agent or broker.
Key Points
• This training is designed to prepare you to help consumers in the FFMs.
• The courses are designed to be taken in order, and each course should be completed before you begin
the next one.
• To be certified, you must complete all required courses, successfully pass all course exams with a score
of at least 80 percent, and meet all other certification requirements.
Module 3 -FFM Consumer Assistance Entities: Roles and Responsibilities
Introduction
A variety of consumer assistance entities help consumers in the Federally-facilitated Marketplaces (FFMs). Each
consumer assistance entity has specific roles and responsibilities. Assisters in FFMs are responsible for
providing fair, accurate, and impartial information to consumers about the full range of qualified health plans
(QHPs) options and insurance affordability programs for which they are eligible. By the end of this module, you
should be able to understand the following concepts and accomplish the tasks below them.
Consumer Assistance Entities
Identify the different types of consumer assistance entities available to assist consumers in the FFMs
Roles & Responsibilities
Identify the roles and responsibilities of each consumer assistance entity
Strategies
Identify strategies to provide fair, accurate, and impartial information to consumers regardless of your own
opinions or preferences
Consumer Assistance Entities
Different types of consumer assistance entities are available to help consumers in the FFMs, including
Navigators and certified application counselors (CACs).
You should be aware of differences between these entities and the consumers they help. Differences may relate
to:
• Roles and responsibilities
• Operational aspects (e.g., funding)
Navigator Duties
Navigators are required to fulfill specific duties.
FFM Navigator Duties:
Beginning with Navigator grants awarded in 2022, including non-competing continuation awards, Navigators are
required to provide information on and assistance with all of the following topics:
• Understanding the process of filing Marketplace eligibility appeals;
• Understanding and applying for hardship and affordability exemptions granted through the Marketplace
for consumers age 30 and older seeking to enroll in a Catastrophic plan;
• Marketplace-related components of the premium tax credit reconciliation process, and understanding the
availability of Internal Revenue Service (IRS) resources on this process;
• Understanding basic concepts and rights related to health coverage and how to use it; and
• Referrals to licensed tax advisers, tax preparers, or other resources for assistance with tax preparation
and tax advice related to consumer questions about the Marketplace application and enrollment process
and premium tax credit reconciliations.
Reminder: In your role as an assister, you should not provide tax or legal advice to consumers. While you may
educate consumers about their rights related to health coverage, you should not, in your role as an assister,
recommend that consumers take specific action with respect to these rights.
Centers for Medicare & Medicaid Services (CMS) will continue to provide all assisters with additional information
related to these assistance activities through webinars, job aids, and other technical assistance resources.
Standards Related to Essential Health Benefits:
Navigators in FFMs must be prepared to inform consumers of the essential health benefits (EHB) that QHPs
must cover in the FFM(s) they service. For plan years beginning on or after January 1, 2020, states may select
which benefits will be EHB in their state. All plans offered in the Marketplace must cover the 10 essential health
benefits categories, but the specific items and services covered within each benefit category may vary based on
state requirements and plan design.
Remote Application Assistance:
Navigators in FFMs aren’t required to maintain a physical presence in their Marketplace service area. In some
cases, Navigators may provide remote application assistance (e.g., online or by phone), provided that such
assistance is permissible under their organization’s contract, grant terms and conditions, or agreement with CMS
and/or their organization.
CACs in FFMs may also provide remote application assistance if such assistance is permissible with their
Certified Application Counselor Designated Organization (CDO).
For guidance on obtaining consumers’ consent remotely over the phone, visit Marketplace.cms.gov/technical-
assistance-resources/obtain-consumer-authorization.pdf.
Navigator Roles and Responsibilities
Hi! I'm Carrie. I am a Navigator. Navigators play an important role in the FFMs by helping consumers apply for
and enroll in coverage. Navigators are certified and funded by the Marketplace in which they operate.
Among other things, Navigators are prohibited from charging consumers for any assistance related to their
Navigator duties.
As an FFM Navigator, I am required to:
• Maintain expertise in eligibility, enrollment, and program specifications;
• Conduct public education activities to raise awareness about the FFMs;
• Provide information and services in a fair, accurate, and impartial manner;
• Facilitate selection of a QHP;
• Provide information in a manner that is culturally and linguistically appropriate to consumers;
• Refer consumers with questions, complaints, or grievances about their health plan, coverage, or a
determination under such plan or coverage to state offices of health insurance consumer assistance or
health insurance ombudsmen or other appropriate state agencies; and
• Make sure consumers are informed of the functions and responsibilities of Navigators before receiving
assistance, including that Navigators are not acting as tax advisers or attorneys when providing
assistance as Navigators and cannot provide tax or legal advice.
Beginning with Navigator grants awarded in 2022, including non-competing continuation awards, I am also
required to provide information on and assistance with all of the following topics:
• Understanding the process of filing Marketplace eligibility appeals;
• Understanding and applying for hardship and affordability exemptions granted through the Marketplace
for consumers age 30 and older seeking to enroll in a Catastrophic plan;
• Marketplace-related components of the premium tax credit reconciliation process and understanding the
availability of IRS resources on this process;
• Understanding basic concepts and rights related to health coverage and how to use it; and
• Referrals to licensed tax advisers, tax preparers, or other resources for assistance with tax preparation
and tax advice related to consumer questions about the Marketplace application and enrollment process
and premium tax credit reconciliations.
CMS will continue to provide all assisters with additional information related to these assistance activities through
webinars, job aids, and other technical assistance resources.
Review Navigator Program Standards and the latest HHS Notice of Benefit and Payment Parameters for a
complete list of Navigator duties and responsibilities.
CAC Roles and Responsibilities
Hello! I'm Elizabeth. I am a CAC. CACs are staff or volunteers of organizations designated by the FFMs to
perform CAC duties. We perform many of the same functions as Navigators, like educating and helping
consumers complete FFM applications for coverage and insurance affordability programs.
Unlike Navigators, CACs aren't required to conduct outreach or public education activities. They must assist
consumers who seek individual market coverage in their FFM service area. CACs are permitted, but not required,
to help small employers submit applications and obtain eligibility determinations through the Small Business
Health Options Program (SHOP) website. While they're responsible for providing information in a manner that is
accessible to individuals with disabilities, they can do so either directly or through referrals to Navigators or the
FFM Call Center.
Unlike FFM Navigators, CACs aren’t required to comply with Culturally and Linguistically Appropriate Services
(CLAS) standards beyond any existing obligations they may have, although they are encouraged to utilize CLAS
standards as a resource. You will learn more about CLAS standards in the Cultural Competence and Language
Assistance course.
In an FFM, CDOs can include community health centers, hospitals, health care providers, certain types of social
service agencies, and governmental entities.
CACs in FFMs are certified by their CDOs.
As a CAC in an FFM, my responsibilities include providing information to consumers about the full range of QHP
options and insurance affordability programs (e.g., Medicaid) for which they are eligible, which includes:
• Providing fair, accurate, and impartial information that assists consumers with submitting the eligibility
application;
• Clarifying the distinctions among health coverage options, including QHPs;
• Helping consumers make informed decisions during the health coverage selection process;
• Assisting consumers as they apply for QHP coverage and insurance affordability programs through an
FFM; and
• Facilitating enrollment of eligible individuals in QHPs and insurance affordability programs.
Like Navigators, CACs in FFMs aren’t permitted to charge consumers for assistance related to the FFM.
Providing Fair, Accurate, and Impartial Information
You must always provide fair, accurate, and impartial information, which includes providing information that
assists consumers with submitting their eligibility applications; clarifying the distinctions among health coverage
options, including QHPs; and helping consumers make informed decisions during the health coverage selection
process.
Additionally, if you have a non-disqualifying relationship with a health insurance company, you must generally
disclose that relationship to consumers. You’re expected to help consumers by focusing on their expressed
interests, needs, and desires, not on your own interests or those of any health insurance company.
You must follow specific conflict-of-interest requirements as a Navigator or CAC in an FFM. Specifically, you
must make sure that you and your organization don’t have a relationship that could interfere with your ability to
provide unbiased outreach and enrollment assistance to consumers.
As a best practice, you should help consumers choose coverage that best meets their expressed interests,
desires, and needs, including but not limited to their:
• Ability to afford paying for coverage;
• Health care needs, such as coverage of treatments for any health conditions;
• Desire to keep a certain doctor or visit doctors in a certain location; and
• Families' health coverage needs, if applicable.
Non-disqualifying relationship
A non-disqualifying relationship is a relationship that doesn't prevent you from becoming an assister. Some
relationships that present a conflict of interest are completely prohibited for certain assister types.
Conflict-of-interest Requirements
For more information about the conflict-of-interest requirements that apply to your assister type, refer to the
Assister Do’s and Don'ts presentation.
Conflict-of-Interest Disclosure Requirements
If you have certain relationships with health insurance issuers or stop loss insurance issuers, these relationships
could prevent you from providing fair and impartial assistance to consumers.
In Navigator organizations, the following individuals must follow certain duties, prohibitions, and disclosure
requirements:
• Staff and volunteers of a Navigator organization
• Sub-grantees or subcontractors of a Navigator organization
• Anyone supervising Navigator program activities
• Anyone engaging in outreach and education activities
These duties, prohibitions, and disclosure requirements don’t apply to those who aren’t involved with the
organization's Navigator programs.
Individuals or entities subject to the conflict-of-interest requirements for Navigators in FFMs must provide
information and services to consumers in a fair, accurate, and impartial manner.
Individuals or entities that perform Navigator services and individuals or entities that perform work related to
Navigator program activities must not be:
• A health insurance issuer, issuer of stop loss insurance, or a subsidiary of either; or
• An association that includes members of, or lobbies on behalf of, the insurance industry; or
• An association that receives direct or indirect consideration, including any form of compensation, from a
health insurance issuer or issuer of stop loss insurance in connection with the enrollment of any consumer
in a QHP or non-QHP.
The Assister Conflict of Interest Requirements webinar provides more information about conflict-of-interest
requirements for each assister type.
Providing an Accurate Description of the FFMs
Providing fair, accurate, and impartial information includes accurately describing the FFMs.
To accurately describe the FFMs, you might need to:
• Access information about the FFMs online to help keep consumers informed while they make their
decisions.
• Establish operating procedures for finding information about the FFMs that will help you effectively assist
consumers (e.g., create a list of key resources and contacts).
In interactions with consumers, you should remain flexible, ask questions, listen, and provide the information they
need to make informed decisions.
Tips on Effectiveness
You should:
1. Understand the coverage options and insurance affordability programs available through the FFMs,
including Medicaid and the Children’s Health Insurance Program (CHIP).
2. Tell consumers about the full range of QHP options and insurance affordability programs for which they
are eligible and help them find coverage that best fits their budgets and specific needs.
3. Use the resources available on the technical assistance resources page at Marketplace.cms.gov
to:
i. Help inform consumers about their coverage options.
ii. Answer any questions you may have about your role as an assister.
4. Visit HealthCare.gov, CMS.gov, and Marketplace.cms.gov
to find resources to help you better serve
consumers, including language assistance resources (like translation services) and educational materials.
5. Connect with community organizations to learn more about the characteristics and needs of communities
in your area.
Knowledge Check
You’re now meeting with Ebele, who is eligible for coverage through an individual market FFM and would like to
enroll in a specific health plan that has low monthly costs. Four years ago, you worked for the health insurance
company that offers this health plan. To be fully open and honest and to comply with FFM assister conflict-of-
interest requirements, you let Ebele know that you previously worked for this company. After reviewing the health
plan she is interested in, you realize it has low monthly costs but it doesn't cover her specific diabetes treatment
needs. What should you do to provide her with fair, accurate, and impartial information?
Answer: You should tell Ebele that the plan she's most interested in doesn't cover her specific diabetes treatment
needs, help her find health plans that offer coverage for her diabetes treatment needs, and let Ebele make her own
decision about which plan to choose.
Key Points
• Two types of consumer assistance entities are available to help consumers find coverage through the
FFMs: Navigators and CACs.
• These consumer assistance entities are responsible for helping consumers enroll in coverage through the
FFMs.
• Consumer assistance entities have different roles and responsibilities they must fulfill as they assist
consumers in the FFMs. These responsibilities vary depending on the type of entity and range from
conducting public education activities to assisting small employers with finding coverage.
• Assisters are responsible for providing fair, accurate, and impartial information.
• Assisters must tell consumers about all QHP options and insurance affordability programs for which they
are eligible and should help consumers choose coverage that meets their budgets and specific needs.
Module 4 – Assister Resources
Introduction
You’ll feel more capable and confident in your ability to provide assistance to consumers when you have up-to-
date resources. By the end of this module, you should be able to understand the following concepts and
accomplish the tasks below them.
Centers for Medicare & Medicaid Services (CMS) Resources
List CMS resources available to assisters like manuals, toolkits, newsletters, and webinars
Internal Revenue Service (IRS) Resources
List IRS resources available to assisters like consumer tax forms and premium tax credit forms
IRS Form 1095-A and Form 8962
Describe how to use IRS Form 1095-A and IRS Form 8962
Marketplace.cms.gov Resources Overview
Marketplace.cms.gov is your best source for Marketplace tools and materials to help you counsel consumers.
This is the official CMS website for assisters. The site consists of three main areas.
Applications, Forms, & Notices.
This part of the site contains paper application forms for individuals and families seeking Marketplace coverage
(with and without financial assistance) as well as job aids in various languages.
Technical Assistance Resources.
This page has resources that explain eligibility, enrollment, tax credits, exemptions, and more. You'll also find
previous assister newsletters and webinars. Finally, this section houses the Marketplace assister toolkit and
training for Navigators, agents, brokers, and other assister types.
Outreach & Education.
This part of the site has materials for consumers, resources for presentations, and promotional tools. Examples
include fact sheets, postcards, brochures, templates, press resources, multimedia presentations, and
Marketplace research.
Standard Operating Procedures Manual for Assisters in the Individual FFMs
Another resource located at Marketplace.cms.gov is the Assister's Standard Operating Procedures (SOP)
Manual. You can find the SOP Manual in the Marketplace assister toolkit under ʺTechnical Assistance
Resources.ʺ After you have completed this certification training, the SOP Manual serves as your primary guide to
helping consumers with activities like enrolling in health coverage in the individual market Federally-facilitated
Marketplaces (FFMs).
The SOP Manual includes information on:
• Preparing, completing, and updating individual market FFM applications for coverage
• Enrolling in coverage through an individual market FFM
• Understanding eligibility determinations for enrollment in coverage through an individual market FFM
application
• Resolving data matching issues (DMIs)
• Renewing eligibility and enrollment for coverage through an individual market FFM
• Understanding the process of filing individual market FFM eligibility appeals
Assister Newsletters, Webinars, and Communications
Additional resources for assisters include:
Assister Email Blasts: CMS routinely sends out assister email blasts with important updates for the assister
community. To sign up for these, visit the CMS Subscriber Preferences page and log in using your email address
to select the subscriptions you would like. To find the assister-related subscriptions, scroll down to the heading
"CCIIO" to access the options listed:
• FFM Assister - Navigator Grantee Updates (for Navigator updates and webinar announcements)
• FFM Assister - Certified Application Counselor (CAC) Updates (for CAC updates and webinar
announcements)
• No Surprises Act Dispute Resolution (for information and updates regarding the No Surprises Act)
You may also update your subscriptions, modify your password or email address, or stop subscriptions at any
time on your Subscriber Preferences page. If you have questions or problems with the subscription service,
please contact subscriberhelp.govdelivery.com.
Webinars: Whether you’re a new or returning assister, we encourage you to participate in the assister webinar
series for additional training opportunities. Webinars cover various Marketplace and health coverage topics and
provide up-to-date information about the latest tools to help consumers.
To attend Marketplace Assister Webinars, you will be required to create or update a REGTAP account and then
register for the Marketplace Assister 2023 Webinar Series. Assisters will only need to register one time for the
series to be invited to all upcoming webinars. Once registered for the series, you will receive E-flyers announcing
upcoming webinars with specific details on topics, time, and dates.
Step 1: Create a REGTAP Account or update your existing Account:
To create a REGTAP account, go to Regtap.cms.gov and select “Create an Account”. Complete the form and
select "Submit." You will receive an email to complete the process.
For new accounts and existing REGTAP users, please be sure to select your correct applicable Organization
Type. For the Federally-facilitated Assisters Group, there are six unique organization types; please select the
organization type that most closely represents your organization.
Selecting the appropriate organization type helps ensure you receive communication relevant to your
organization and appropriate event access. Please do not select “issuer” as part of your organization type.
Issuers are insurance companies such as Aetna, Blue Cross–Blue Shield, etc. Content is not relevant to Issuers,
and Issuers are not permitted to attend our webinar series.
Step 2: Register for the Marketplace Assister 2023 Webinar Event Series
Log into your REGTAP account and select the "Training Events" icon. Next, select the event. Lastly, select
“Register Me.” You will receive notification of registration status within 30 minutes of registering for a training
event. You will only need to register once to be confirmed for all event dates within the Marketplace Assister 2023
Webinar Series. When you register for the entire series, you will automatically be registered for EACH webinar.
Job aids: Job aids are available in the Technical Assistance Resources section at Marketplace.cms.gov. These
job aids cover a variety of different topics like:
• Application process assistance
• Eligibility and enrollment
• ID proofing
• Special populations (like immigrants)
• Special Enrollment Periods (SEPs)
Marketplace.cms.gov Resources Activity
Let’s practice finding resources you can use to help consumers. We will start at the Marketplace.cms.gov home
page. A family needs a paper application to apply for Marketplace coverage because the HealthCare.gov website
is down.
The Applications, Forms, & Notices button will take you to the paper application forms for Marketplace
coverage (with and without financial assistance) for families and individuals and family application job aids in
various languages. You can also find eligibility appeals forms and exemption applications here.
Marketplace.cms.gov Resources Activity (Continue)
A family needs a paper application to apply for Marketplace coverage because the HealthCare.gov website is
down.
The Technical Assistance Resources button will take you to a list of assister webinars that contain important
updates. You’ll also be able to find information about various topics, like Marketplace plans, special populations,
SEPs, canceling or terminating Marketplace plans, and SHOP Marketplace resources.
Marketplace.cms.gov Resources Activity (Continue Part 2)
The Outreach & Education button will take you to multimedia files that you can share with consumers to help
you explain the Marketplaces to them. You’ll also find resources for presentations and promotional tools. These
materials contain information tailored to various audiences, including newly enrolled consumers, special
populations, and SHOP Marketplace consumers.
Keeping Up With Marketplace News and Information
When communicating with consumers, it's important to have the latest, most accurate information available. You
can sign up for updates directly at HealthCare.gov for the most up-to-date information about the Marketplaces.
You can also check out videos and other resources available at Marketplace.cms.gov. CMS shares updates
during Marketplace assister webinars and in email blasts. Once registered for a REGTAP account and the
Marketplace assister webinar series, you will receive email updates each time new information is added to the
REGTAP site. Other resources that are tailored to specific state issues, like local nonprofit groups, may also be
helpful.
You can keep up with the latest Marketplace news through other social media channels, including the following:
• YouTube: Watch youtube.com/user/HealthCareGov for videos highlighting important information about
the Marketplaces.
• Facebook: "Like" facebook.com/HealthCare.gov.
• Twitter: Follow @HealthCareGov on Twitter for up-to-date Marketplace news.
You can share these links and encourage consumers to visit these sites.
IRS Consumer Tax Forms and Resources
You have learned about key resources at Marketplace.cms.gov. Now, we will review forms and resources at
IRS.gov that might be useful to you when helping consumers. Remember, you aren’t permitted to provide tax
advice to consumers in your capacity as an assister.
IRS.gov is the official IRS website, and it provides information on the Affordable Care Act (ACA)-related tax
benefits and responsibilities for individuals and families. This includes information about the individual shared
responsibility provision and premium tax credit provision. It also provides basic information about how the health
insurance choices consumers make may affect their tax returns.
Marketplace-related IRS electronic publications include:
• Pub. 5187 — Affordable Care Act: What You and Your Family Need to Know
• Pub. 974 — Premium Tax Credit
• Pub. 5093 — Health Care Law Online Resources
• Pub. 5120 — Premium Tax Credit: Fact Sheet
• Pub. 5152 — Premium Tax Credit: Report Changes to the Marketplace
• Pub. 5172 — Facts about Health Coverage Exemptions
Remember, important forms found at IRS.gov include Form 8962 (for reconciling the premium tax credit) and
instructions for using Form 1095-A (the Health Insurance Marketplace Statement).
The IRS website also contains information about IRS-related rules and responsibilities for employers and tax
provisions for insurers, tax-exempt organizations, and other businesses.
Knowledge Check
Hi! My name is Ann, and I am a new assister. Can you tell me where to find resources I can use to help me do
the best job I can to assist consumers? Visit the Marketplace.cms.gov website to answer this question.
Answer: You should show Ann these areas on Marketplace.cms.gov that provide important information for
assisters and consumers. You should also tell Ann about the Marketplace assister webinar series and how to
subscribe, as webinars provide important up-to-date information for assisters.
Conclusion
Great job! In this course, you reviewed what courses make up the assister curriculum, learned important terms,
clarified your roles and responsibilities as Federally-facilitated Marketplace consumer assistance entities, and
studied how to provide fair, accurate, and impartial information to consumers.
You have successfully completed this course! Close this browser window to leave the course.
Resources:
Consumer Assistance Programs (CAPs):
General information about CAPs and links to program contact information by state.
CMS.gov/CCIIO/Resources/Consumer-Assistance-Grants
Technical assistance resources:
A collection of resources for assisters to reference while helping consumers in the FFMs.
Marketplace.cms.gov/technical-assistance-resources
Marketplace.cms.gov:
Official CMS website offering information and resources on the Health Insurance Marketplace
®1
.
Marketplace.cms.gov/
HealthCare.gov:
A resource where consumers can create a healthcare.gov account and access information about health coverage
and the Health Insurance Marketplace
®
. Healthcare.gov/
HealthCare.gov Small Business Health Options Program (SHOP):
A resource where small employers (generally one with 1-50 employees) can access information about Small
Business Health Options Program (SHOP) coverage.
HealthCare.gov/small-businesses/employers/
Federally-facilitated Marketplace (FFM) Call Center:
Contact information for the FFM Call Center, a 24-hours-a-day, 7-days-a-week resource for consumers seeking
health coverage through the FFMs. Healthcare.gov/contact-us/
Office for Civil Rights (OCR) website:
Official website of HHS OCR, which contains information about federal regulations on discrimination and privacy.
HHS.gov/ocr/.
Consumers who believe they have been discriminated against on the basis of race, color, national origin, sex,
age, disability, or religion may file a complaint with OCR at HHS.gov/civil-rights/filing-a-complaint/complaint-
process/index.html.
1
Health Insurance Marketplace® is a registered service mark of the U.S. Department of Health & Human
Services.
