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How to Protect Yourself Against ACA Fraud

Four tips on how to defend against scammers during Health Insurance Marketplace open enrollment

Woman using a navigator to sign up for health insurance

Alan Diaz/Associated Press

A woman hears her ACA enrollment options from an agent. 

En español | As millions of Americans review their Affordable Care Act (ACA) coverage and sign up or change their health insurance plans during open enrollment, scammers are also working to take advantage of consumers.

ACA open enrollment started Nov. 1 and ends in most states on Dec. 15. Officials at healthcare.gov and the Federal Trade Commission (FTC) are warning consumers to beware of fraudsters offering insurance deals that seem too good to be true — because they probably are.

“One big scam, especially around open enrollment, is companies calling consumers offering online what they claim to be comprehensive health insurance,” says Jason Adler, assistant director of the FTC’s Midwest Region. “What they are actually providing is a discount plan or other substandard product that doesn’t give consumers the coverage they think they are getting.”

Here are four ways fraudsters try to get valuable personal information from you, or sell you phony or substandard health coverage.

1. The Cold Call

You get a phone call or an uninvited visit to your home from someone who says they are from the Health Insurance Marketplace (aka Marketplace) and need more information to finish your application, including your banking or credit card numbers.

What you should do: This is probably a scam. If you have applied for insurance through the Marketplace, you may get a follow-up call asking you to verify or provide more information. But you will never be asked for a bank name or account number. Here’s how healthcare.gov says you can make sure the call is legitimate:

  • Use caller ID to check the number. The display should show one of these: Health Insurance MP; InsMarketplace; 855-997-1890 or 844-477-7500.
  • The person calling is supposed to say they are from the Marketplace and give you his or her first name and agent ID number. Write this information down so you can later verify that they do work for the Marketplace.

Healthcare.gov suggests that if you are at all suspicious about any call, ask the representative to mail you a letter with instructions about how to complete your application. The website also has information about when and how you should report suspected fraud. If you have confirmed the person is a Marketplace representative, you might be asked the following questions to finish your enrollment:

  • The caller may ask you to confirm what you put on your application, including your full name and address.
  • They may also ask you to verify other information, such as your Social Security number, application ID, policy ID, user ID, date of birth or phone number.
  • And, they may ask you to confirm income, and information about how many people are in your household and where you work.

2. The Fee for Help

You get a call from someone saying they are a navigator and can help you choose and apply for a Marketplace plan. They say they will charge a fee.

What you should do: Hang up the phone. The Marketplace has trained assisters in every state who can help you sort through the plans and answer questions, and these workers will do so free of charge. To find assistance near you, go to the local help section of healthcare.gov. You’ll be asked for your zip code. When the page for your area opens, you can decide if you only want to talk to a navigator or also want a list of agents or brokers in your area.

3. The Insurer Call 

You get a call from someone saying they are an insurer and can sign you up for a plan over the phone.

What you should do: This may or may not be legit. Adler suggests listening to their pitch, and then asking them to send you additional information in writing. If they are sending you an e-mail, make sure you have a virus scanner on your computer and don’t click on a link that sends you to an unfamiliar website. You may also call your state insurance department to make sure the company the caller says they are representing is legitimate.

Chances are, once you start asking questions and refuse to turn over any personal or credit card information, if the caller is a scammer he or she will hang up the phone.

You can also check whether the caller is from a real insurance company by going to the National Association of Insurance Commissioner’s consumer information page to see if that insurer is licensed and selling a reputable product.

4. The Fake Website

Scammers create phony websites that look genuine because they display the logos of reputable insurance companies — like Blue Cross — or even organizations such as AARP. These sites claim to offer comprehensive health insurance.

What you should do: Google the official website of the company and see if it takes you to the exact same page you’ve been looking at. Then contact that company directly to check whether the deal offered by the website you first looked at is the real thing.

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