FRAUD RESOURCE CENTER
En español | The route to getting the right health coverage can seem like a bewildering bureaucratic maze, especially since the advent of the Affordable Care Act (ACA). Shady operators count on that confusion, the better to sell you insurance products and health services that deliver far fewer benefits than promised, or none at all.
These scams proliferate when health care is in the news and on consumers’ minds — for example, during the annual open enrollment periods for ACA and Medicare. Fraudsters try to convince you they have a simple solution to the complexity and expense of getting covered. They cold-call potential marks or generate leads through websites offering information about “comprehensive” health plans that meet “Obamacare” requirements. Some feature the names and logos of major insurers, or even AARP. People who respond are peppered with pitches promising full coverage with low premiums, deductibles and co-pays.
The resulting policies turn out to be, at best, far skimpier than advertised or, at worst, outright fakes. Often victims are really buying medical discount plans, in which consumers pay a monthly fee to get reduced prices from participating medical providers. Some discount programs are legitimate, but as the Federal Trade Commission (FTC) warns, they are not a substitute for insurance. In November 2018, the FTC filed a complaint against a Florida company that allegedly bilked more than $100 million from consumers by dressing up discount-plan memberships as comprehensive coverage, leaving buyers uninsured and often stuck with big medical bills.
During ACA enrollment, which runs from Nov. 1 to Dec. 15 in most states, scammers get busy impersonating representatives of the government-run Health Insurance Marketplace. They’ll tell you they need personal information to verify an application or that they can help you choose the right plan, for a fee. Treat such solicitations, and any offers of deep-discount coverage, with a healthy dose of skepticism.
- High-pressure sales pitches that push low-cost plans or offer special rates if you sign up right away.
- Claims that a plan is licensed under ERISA, the federal Employee Retirement Income Security Act. Insurance companies are licensed by the states, not by any federal body.
- A plan requires you to join an “association” or “union” to get covered. These may be fake organizations designed to create the illusion that you are buying group health insurance.
- Someone contacting you about health coverage claims to be from the government. No government representative will ever try to sell you insurance.
- Do compare rates. Premiums for “comprehensive” coverage that are far lower than what you see elsewhere are probably too good to be true.
- Do confirm with your state insurance commissioner that a plan provider is licensed.
- Do insist on seeing a statement of benefits or a complete copy of the policy.
- Do learn about the difference between medical discount plans and health insurance, and ask specific questions to make sure you know what you’re getting.
- Do research an association or union named in an insurance pitch. Look for a U.S. street address and phone number, and for evidence of activity other than selling health insurance.
- If an unfamiliar company says it sells plans through a major insurer like BlueCross BlueShield, do check it with the big name.
- Don’t enter personal information on a website in exchange for a price quote. You are likely setting yourself up for identity theft or a barrage of sales calls.
- Don’t keep talking to a sales agent who gives vague or evasive answers to coverage questions or tells you the details are “in the brochure.”
- Don’t sign up for a plan if the bar for acceptance seems too low — for example, if you are not required to get a physical or provide a medical history. Some scam sites claim you can get insurance just by filling out a form.
- Don’t give bank, credit card or personal information, or make a payment, to someone who calls or comes to your door regarding ACA coverage. Assistance in navigating the Health Insurance Marketplace is available for free all over the country (go to HealthCare.gov and click “Find Local Help”), and real Marketplace representatives will not ask you for personal or financial data.
- If you suspect a health insurance scam, file a complaint with the FTC online or at 877-382-4357, and contact your state insurance department.
- HealthCare.gov, the official Affordable Care Act website, has information on preventing and reporting suspected Health Insurance Marketplace scams.
- The Coalition Against Insurance Fraud, an alliance of consumer advocates, state agencies, insurance companies and other businesses, has detailed online fact sheets about various health care scams.
Published Jan. 18, 2019
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