10 tips for avoiding health insurance scams

May 22--Shopping for health insurance is a daunting process that has gotten more confusing, as plans that do not meet the Affordable Care Act’s benefit requirements for comprehensive insurance become more available.

Short-term, limited-duration and other limited-benefit insurance plans are not required to cover pre-existing conditions, prescription drugs, mental health or maternity. The ACA restricted the duration of these plans to three months, but the Trump administration loosened those rules. Now, short-term plans can cover individuals year-round.

Republicans argue short-term and other limited-benefit plans should be available for people who do not want to pay for more coverage than they think they need. But anyone who’s Googled “Obamacare plans” or “Affordable Care Act insurance” knows it can be hard to tell the difference between comprehensive health insurance and these other kinds of insurance plans.

Democrats are pushing legislation that would restore the ACA protections, but it’s unclear what will come of the bills without Republican support.

In the meantime, if you’re shopping for full health insurance, your best bet is to be a smart and cautious shopper. Here are some tips:

Check the URL

The best way to know you’re in the right place is to double (triple!) check the URL, which is the website address. The federal marketplace website is healthcare.gov.

Search engine ads often use “healthcare.gov” in the hyperlinked text people click on to get to the website, but look closely at the URL just below to see the actual website address.

All government websites are “.gov” domains, while private websites use .com, .org or .net. Many companies have scooped up websites people might land on if they miss a letter typing or use the wrong domain.

Check for a disclosure

Insurance quote websites are required to note that they are not affiliated with the government, though this detail is often in small print at the bottom of the page. The privacy statement at the bottom will give more information about who owns the website.

Did you have to answer health questions?

The ACA prohibits comprehensive health plans from basing coverage on your health status, which means if you had to answer questions about whether you smoke or have ever been pregnant, you’re on an insurance quote website where at least some of the plans are allowed to underwrite (denying coverage or charging higher prices) for health conditions.

Can you window shop?

Government marketplace websites allow consumers to compare plans without creating an account or submitting any contact information.

Did you give out your phone number?

Healthcare.gov doesn’t ask for your phone number on its homepage so that an agent can call you. If an agent calls to help you sign up for insurance, it is a private broker.

Get good help

Healthcare.gov has a search tool to help you find navigators (groups that receive federal funding to assist with enrollment) and brokers licensed to sell comprehensive, ACA-compliant plans.

Research the agent

Search by name in Pennsylvania’s insurance broker registry to see if your agent’s license is up to date. Once on an agent’s license number page, click “appointments” to see which insurance carriers he or she has relationships. If none of them are major medical insurance companies, your agent won’t be selling you comprehensive health insurance.

Research the plan

Write down the plan name and carrier, and check their status with the state insurance department online or by calling (717) 787-2735. If the agent is reluctant to give you this information, that may be a sign he or she hasn’t been upfront about the plan’s coverage.

Get it in writing

All major medical plans have a summary of benefits document that outlines exactly what is covered under the plan and how services are paid for. Look closely for wording about exemptions and limitations, especially if the document you receive looks more like a glossy brochure than a boring legal document.

Think on it

Brokers selling insurance over the phone can be convincing and pushy -- but you’re not obligated to hand over your credit card number right away. Insist on having the contract agreement emailed or mailed to you, to review carefully, before signing.

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