Watch out for health insurance that seems too good to be true this open enrollment season

It took Kelly Macauley almost a year to realize that the health insurance plan she purchased when buying insurance last October wasn’t really insurance. Sure, red flags popped up along the way, but when she called to complain, she was met with an explanation that sounded reasonable enough that she kept paying the $700 monthly premium, she said. Told.

She said she was told she hadn’t paid for her medical bills because the hospital had submitted them incorrectly. was her underwriter, not the actual insurance company. She had not received her packet of policy welcomes because the company was saving paper and passing those savings on to her customers.

And this summer, a 62-year-old retired teacher who recently moved to South Carolina from the Philadelphia area learned that last year’s hip replacement bill was only paid for $120 and had a balance of over $40,000. I was. She said that when she was purchasing her insurance, she was confident that the surgery would be covered, but the plan she purchased wasn’t insurance, it was called a health care sharing ministry. turned out to be part of the

A healthcare sharing ministry is an alternative to health insurance where members agree to share medical costs. These are often religiously based and may be cheaper than traditional insurance, but they don’t always cover medical expenses for members, according to a Commonwealth Fund report.

“That was never said to me,” McCauley said. “Honestly, I believed I was buying legitimate medical insurance.”

Starting November 1, millions of Americans will purchase health insurance for 2023 during a period called “open enrollment.” Through federal and state insurance marketplaces, consumers can purchase affordable medical law-compliant health insurance plans and see if they qualify for financial assistance.

But the influx of coverage purchases, experts say, is also often cheaper than comprehensive coverage, but much more for those who sell alternative products, such as short-term health insurance and health care sharing. It warns that it offers an opportunity to offer less protection. While these alternatives are themselves legal, experts say misleading marketing allows consumers to buy health insurance that excludes protection against pre-existing conditions and can cost patients large medical bills. We warn you that you may be induced to purchase comprehensive coverage to do so.

Joanne Volk, co-director of Georgetown University’s Center for Health Insurance Reform, said:

Volk has identified clear signs of that wrong path: when the person selling the plan starts asking about your health history, or refuses to send any information about the plan outright, or refuses to pay. You agree to provide that information only after you have done so. information. Volk co-authored His 2021 Secrets on Misleading Marketing Practices His Shopper, according to his report, one broker cited patient privacy laws as reason not to share information about medical plans I misquoted his HIPAA.

“It’s a hoax,” Volk said. “When you’re committing fraud, there are no boundaries.”

In a statement to KHN, Jericho Share spokesperson Mark Hubbard said the organization could not discuss Macquarie’s case without her prior written approval, but that misrepresentation in any part of its program would not be permitted. and unethical behavior will not be tolerated.

Nationally, legislators and regulators are looking at how health care plans are marketed. Oregon Democrat and Senate Finance Committee chairman Ron Wyden is investigating complaints about the marketing of the Medicare Advantage Plan. And in May, the Centers for Medicare & Medicaid Services noted that complaints about the marketing practices of Medicare Advantage and Medicare Prescription Drug Benefit plans had risen from 15,497 in 2020 to at least 39,617 in 2021. .

Delaware Insurance Commissioner Trinidad Navarro also chairs the National Association of Insurance Commissioners’ Anti-Fraud Task Force.

Multiple factors are driving the increase, Navarro said. Rising healthcare costs can drive up the cost of regulated healthcare plans, such as those complying with the Affordable Care Act. Higher costs drive more Americans to look for cheaper alternatives. These types of plans have surged under President Donald Trump’s administration, Navarro said.

Elected Democrat Navarro said, “I don’t want to sound political.” related to these plans. ”

Finally, states are the primary regulators of insurance, so quelling healthcare fraud can be like playing a game of whack-a-mole, Navarro said.

To combat this tactic, Navarro said, insurance regulators across the country have created what he describes as “confluence pages” to share information about bad actors with each other. Navarro said regulators are discussing creating a public search tool for consumers to search for complaints against health insurance brokers, similar to his BrokerCheck tool created by financial industry regulators to monitor stockbrokers. It is said that there is

For now, he suggests working with Healthcare Navigator. Healthcare Navigator helps consumers enroll in plans through, the official health insurance marketplace. Regulators are also taking legal action against misleading sales tactics. In August, the Federal Trade Commission won $100 million in refunds to consumers who said they were “cheated” by fake health plans. Obtained $515,000 in consumer relief from accused insurers.

According to an October court filing, the California Attorney General is investigating Jericho Shea, the Department of Health Care Sharing, which Kelly McCauley said had unknowingly purchased the plan, to file a lawsuit against the Department of Health Care Sharing. Checking for compliance with state requirements.

Hubbard, a Jericho Share spokesperson, said the organization was “appropriately responding” to the Attorney General’s investigation.

Macauley contacted KHN after reading a consumer survey in June that said he thought he was buying insurance, only to later learn that his membership had been sold to the Department of Health Care Sharing. I took

Hubbard said that since that article was published, Jericho Share has automatically refunded new consumers within 72 hours if they request a refund within 30 days of signing up, and that “the It said it did not allow “outsourced marketing” and added a member guide and popup to that page. His website showing Jericho Share is a health care sharing ministry.

The company responded online to Macauley’s bad review on the Better Business Bureau website and asked for more information about her case. She said she provided the information but she didn’t hear back.

After Macaulay tried unsuccessfully to cancel the Jericho Shares plan directly with the company, she called her credit card company to stop them from authorizing any further charges by the company. The credit card clerk told her, “This is a scam,” and offered her a full refund of the insurance premium.

Even if those efforts were successful, Macaulay would be left with tens of thousands of dollars in medical bills because he unknowingly had no insurance.

She’s on the health insurance market again and plans to pick a company she’s heard about before.

“Whatever it costs,” said McCauley.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. KHN is one of the three main operating programs of KFF (Kaiser Family Foundation), along with policy analysis and polls. KFF is a donated non-profit organization that provides information on health issues to the public.

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