Certified Application Counselor

What is a Certified Application Counselor?

Certified Application Counselors (CACs) help people enroll in coverage through the Affordable Care Act’s exchanges/Marketplaces. Each state’s exchange must have a Certified Application Counselor program,¹ with similar training and privacy standards as Navigators. (But Navigators are “held to a higher regulatory standard” and don’t just focus on enrollment. They must also conduct consumer outreach and education, and provide some post-enrollment assistance.²)

In states that use HealthCare.gov as their Marketplace, CACs are overseen by Certified Application Counselor Designated Organizations (CDOs). Examples of organizations that the federally-run Marketplace could designate as CDOs (with staff or volunteers serving as CACs) include community health centers, hospitals, health care providers, Ryan White HIV/AIDS providers, behavioral health or mental health providers; agencies that provide various community social services, local health departments, and libraries.³

Organizations that wish to serve as CDOs — and have their staff or volunteers serve as CACs — do so voluntarily, and they do not receive funding from the Marketplace⁴ (unlike Navigator organizations, which do receive funding from the Marketplace⁵).

The CACs help people understand their health plan options, maintain experience in eligibility, enrollment, and all insurance affordability program specifications; provide information and services in a fair, impartial and culturally competent manner; and facilitate selection of a QHP. But like Navigators, CACs cannot make plan recommendations; that can only be done by a licensed insurance agent/broker.² Unlike Navigators, CACs do not have to perform services beyond enrollment activities, which means they don’t have to conduct education, outreach, or post-enrollment assistance. But they can provide these services if they choose to do so and are properly trained.⁴.