Beware of Health Care Enrollment Fraud
Ellen Allen
Open enrollment for the Affordable Care Act (ACA) gets underway Nov. 1. This is great news as the marketplace offers a variety of affordable insurance options that fit pretty much every budget and situation.
But be cautious as you prepare to make your plan selections. The only official web site is HealthCare.gov.
As a West Virginia resident, you also can use the free ACA enrollment service of the West Virginia Navigator or call 844- 982-2737. In fact, this is what we suggest at West Virginians for Affordable Health Care, as it provides free health insurance enrollment assistance for West Virginians through the Health Insurance Marketplace where four out of five enrollees qualify for health care coverage that costs under $10 per month. The enrollment process typically takes less than 40 minutes.
Beware of fraud
A note of caution. Beware of fake and fraudulent sites and rouge insurance agents. Some unscrupulous brokers are fraudulently enrolling people in coverage, leaving some Americans — including West Virginia residents — unaware that they have been enrolled.
Why? The enticement is monthly commissions paid by insurance companies — amounts that are at least $25 per person and sometimes higher. These small amounts can add up to real money through commissions when multiplied across hundreds of transactions.
Often, consumers who are targeted by rogue agents or brokers don’t know they’ve been enrolled, or that their coverage has been switched to a new plan — without their consent— until they lose access to preferred doctors, learn they have different deductibles, or find they owe taxes for ACA insurance premium subsidies.
These schemes exploit the federal health insurance enrollment system, which requires only minimal proof of identity to encourage and facilitate easy enrollment — a name, birth date and state — for a broker to create or access an account.
According to KFF Health News, the situation is so troubling that federal regulators have blocked two private sector enrollment websites from accessing consumer information through the federal ACA marketplace, citing “anomalous activity.”
This unusual step comes as the Centers for Medicare & Medicaid Services (CMS) is under the gun to curb unauthorized enrollment and switching of ACA plans by unethical agents. CMS received more than 200,000 complaints in the first six months of the year about such actions.
Getting ready
Our experience with enrolling in the ACA is that it takes less than 40 minutes. To make the most of your time with West Virginia Navigator or your self enrollment at HealthCare.gov, you should have some basic information at your fingertips to complete the process:
- Social security numbers of people living in the household.
- Income information of all people living in your household including tips, retirement income, unemployment compensation and rental income.
- Estimated household income.
- Current health insurance coverage of household members including employer based coverage; Medicare; Medicaid; CHIP; COBRA, etc.
- Here is a complete checklist of everything you need to complete your application.
Don’t share your personal information or give money to anyone pressuring you to pay them to keep your Medicaid or CHIP coverage. No one should ask you for money to apply for Marketplace coverage.
Assister organizations will never threaten you or anyone in your household, or ask for credit card information or payment to keep or quality for health care coverage.
Don’t be intimidated by the process. With skillful guidance and just a bit of advance preparation, you will find accessible healthcare coverage that you can actually afford to use.
The 2025 open enrollment period for the ACA is from Nov. 1, 2024 to Jan. 15, 2025. This is the time when individuals and families can enroll in, renew or change their health insurance plans through the Health Insurance Marketplace.
To get coverage starting Jan. 1, 2025, you must enroll by Dec. 15, 2024. If you enroll or change plans after Dec. 15, coverage will start on Feb. 1, 2025.
Originally published by https://westvirginiawatch.com/2024/10/24/beware-of-health-care-enrollment-fraud/
