In July, the federal government began issuing grants for training navigators. In Pennsylvania, the largest award went to Resources for Human Development (RHD), a Philadelphia-based nonprofit human services organization. It hopes to reach 576,000 low-income working Pennsylvanians and their families.
"We are hoping to have 24 people who are navigators across the 10 counties with the highest rates of uninsured residents," including the five-county Philadelphia region, said Laura Line, RHD's corporate assistant director for health care.
To become a navigator you must be hired by a group such as RHD that has received a grant. RHD wants to hire people with experience in health care, social work, insurance, or human resources. It is also partnering with other groups such as the Pennsylvania Health Law Project.
The navigator's course was originally designed to take 30 hours to complete. But the Centers for Medicare and Medicaid Services (CMS), which oversees the navigator program, trimmed it to 20 hours. That's ambitious for anyone unfamiliar with social services or health care - at least it was for me.
Conducted online, the course consists of 14 learning modules, covering things like what is a qualified health plan, privacy and security standards to safeguard consumers' personal information, and the Small Business Health Options Program or SHOP.
All but two of the learning modules - Training Overview and the Standard Operating Procedures - are followed by an exam. You can't advance to the next module until you pass the current section's exam with a score of 80 percent or higher. If you exit a test before finishing, you lose your completed work. You may retake a test as many times as needed to pass.
Even if you pass all the exams (which I eventually did) and are certified (which, to the relief of everyone at CMS, I am not), no one expects navigators to function independently on Tuesday or in the near future. It's just unrealistic. Even with all the scenarios presented, there are way too many unknowns and unique individual situations.
The federal authorities recognize that and have been holding biweekly conference calls with grantees to address issues. CMS is also operating a help desk to field questions. Navigators are required to recertify once a year.
"We are really relying on each other [navigators] to educate ourselves," said Kate Kozeniewski, program coordinator with RHD and a navigator program graduate. "I don't think anyone can do this by themselves."
The first module of the course is Training Overview. It explains the goal of the program and why marketplace is the preferred term: it "better describes what an exchange does and is easier for consumers to understand."
I breezed through the first three modules - Health Insurance Basics, Affordable Care Act Basics, and Marketplace Basics - passing each exam with a perfect score. I was feeling quite smug. And then I opened the Eligibility and Enrollment (E&E) module.
The module covers enrollment dates and effective dates of coverage; programs to help lower cost (Medicaid and Children's Health Insurance Program); premium tax credits and cost-sharing reductions; exemptions to the individual mandate; and the small business health options program marketplace eligibility and enrollment.
E&E is the meat and potatoes of the training, where every prospective navigator's dead-reckoning skills are tested. It wasn't that the modules were long, although at least one was 20 screens. It's that each screen was crammed with stuff like who should apply for this but only if they are exempt from that, which no one will know until they submit this form.
The exam that followed was 17 vexing, multiple-guess questions, almost double the length of the previous exams. Passing meant getting 14 correct answers.
Needless to say, it didn't go well. I shrugged off my first failed attempt. By my fourth rejection, I was cursing so loud that the dog got up and looked at the screen.
I finally passed on my - ah, who's counting? But I'm not the only one who found the E&E test challenging. Kozeniewski was coy about how many attempts it took her to get 14 right answers.
"I'm not going to answer that," she said. "I will say that the tests are definitely tricky."
This article was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health-policy research and communication organization not affiliated with Kaiser Permanente.