Revenue Cycle
and Billing

There has been a substantial increase in the number of individuals signing up for health insurance when compared to the previous years.  Over 528,000 Americans signed up for health insurance through the Affordable Care Act from the start of the 2021 Special Enrollment Period (SEP) and 322,000 of those signups came from March 1 to March 31.   The majority of these new plans occurred in the states of Florida (146,250 selections), Texas (98,082 selections), Georgia (40,098 selections), North Carolina (32,577 selections), and South Carolina (15,666 selections), all of which are states that have resisted Medicaid expansion.  Navigators, within those states, have a substantial opportunity to help get our underinsured, uninsured, and “left behind” populations enrolled in an ACA plan that works for them through the August 15, 2021 extension period.   The U.S. Department of Health and Human Services (HHS) allocated $2.3 million to go toward existing Navigator grantees for the federal health insurance marketplace.  Their outreach efforts focus on alerting and helping the minority communities who have been hit the hardest by the pandemic.

The Medicaid Expansion Argument

Medicaid expansion, under the Affordable Care Act, allows people with family incomes less than 138% of the federal poverty limit— or around $17,000 for an individual and $29,000 for a family of three— to qualify for Medicaid.  To date, 12 of the 50 U.S. states have not adopted Medicare expansion.  A common argument against expanding Medicaid is that it is too expensive.  States have to pay 10% of the cost to cover new enrollees, while the federal government pays 90%.  Historically,  Southern states have expressed opposition to the Medicaid expansion due to concerns about cost, as well as, citing political opposition to the Affordable Care Act as a whole. The 12 states that are holding out on the expansion do not trust that the federal government will continue to provide the 90% funding match; and if the federal government pulled out, the state would then have to bear the brunt of that deficit.

SEP Navigators Within Medicaid Restricted States Have A Great Opportunity

So what does this mean for Navigators within these 12 states?  It means opportunity.  With the SED extension, Navigators have the opportunity to assist thousands of Americans with ACA enrollment.  These newly insured patients seeking treatment within your community, help increase revenue and take the financial burdens off of the providers and community health organizations.  The Covid-19 pandemic has put a great, financial strain on providers and their budgets. Resources are being used to assist in the vaccine rollout and the workload has not decreased.  Navigators, more than ever, need assistance getting patients enrolled during this limited enrollment period.

How Can American Exchange Help Navigators?

As a licensed, certified broker and revenue cycle expert, we have experienced staff ready to help navigators enroll everyone who seeks assistance during the special open enrollment period and manage effective provider reimbursement.  We have established relationships with payers and providers throughout the country and work with translators speaking more than 100 languages to reach individuals who prefer to speak in their native tongues. Since 2013, we have assisted in helping more than 60,000 individuals and families find affordable healthcare.

American Exchange has a proven track record of success with enrollments.  We successfully helped an Orlando-based nonprofit identify and solve issues within their organization which saved them time and money. Ultimately, we have connected over 20,000 individuals living with HIV, to healthcare plans that fit their needs.

How We Helped A Southern CBO Provide Better Access To Care:

  • Architected best-practice financial assessment and reassessment processes 
  • Provided onsite and telephonic financial assessment of 2,000 existing clients and all new patients

 Identified patients:

  • For enrollment in subsidy specific programs 
  • Eligible for Marketplace enrollment 
  • Potentially eligible for Medicaid enrollment


  • Enrolled 160 patients in Marketplace plans in 2019 
  • Expect to enroll 200 patients in Marketplace plans in 2020 
  • Marketplace enrollees have access to insurance to treat all their healthcare needs
  • Freed up 297.5 hours of Non-Profit CBO staff time in a little over 3 months

Let American Exchange help take some of the enrollment burdens off the Navigators’ shoulders.  We are here to help ensure that no one in your community falls through the cracks.  

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