CONSUMER ALERT
Shop smart to avoid health insurance scams

Not all companies that sell health insurance sell good coverage. When you search online, you may find websites that offer health plans that don’t meet legal requirements. Many sites make you think you’re buying from the state’s health insurance marketplace. The websites look real. The plans look affordable. But the health plans often do not offer services or benefits you need. They may not meet state standards. You might end up with big bills if you need care.

Be a smart insurance shopper! This checklist will help you avoid health plans that won’t cover your needs. It will help you find a plan you can trust.

Choose health coverage you can trust

  • Be aware that some websites look like they belong to the Massachusetts Health Connector, the state’s official health insurance marketplace.

    Some websites imitate the state’s official health insurance marketplace. They say they sell “Obamacare” or “Affordable Care Act” coverage. But they don’t. There is only one health insurance marketplace in Massachusetts that offers coverage that meets state and Affordable Care Act standards and offers financial help to those who qualify to lower the cost of health coverage. That’s the Massachusetts Health Connector at www.MAHealthConnector.org. You can also go directly to the single application for MassHealth and Health Connector coverage at www.MAhix.org.

  • Watch out for companies and salespeople that sell insurance without a license or enough coverage.

    Massachusetts residents who search online for health insurance often find websites directing them to agents who sell coverage but don’t have a license from the Massachusetts Division of Insurance that allows them to legally sell insurance to you, or the plans may not meet state standards like Minimum Creditable Coverage. These sites look good, but the coverage might not be good. You may have to pay state tax penalties. You may not qualify for state and federal help to lower your costs.

    SOME WEBSITES TO BEWARE OF:

    • https://www.affordablehealthplans.org
    • https://www.affordable-health-insurance-plans.org
    • https://www.affordablehealthinsurancetoday.com
    • https://www.directhealthinsurance.com
    • https://www.getmehealthinsurance.org
    • https://www.health1nsurance.com
    • https://www.healthcare.com
    • https://www.healthinsuranceusa.org
    • https://www.masshealthplans.com
    • https://www.obamacareplans.com
    • https://www.obamacare-rates.com
    • https://www.valuehealthquotes.com
    • https://health-plan-enrollment.com

  • Beware when websites ask for your phone number or other contact information.

    Many sites ask for your phone number before they will show you the plans they offer.

    They may call you and use high-pressure sales tactics. They may claim they have low-cost, name-brand health plans. Don’t ever give your contact information just to see the plans a company offers. If a salesperson calls to offer health insurance, use these tips to protect yourself:

    • Research a phone number or company online (if possible) to check its history, including “complaint,” “scam” or “fraud” in your search.
    • Never give your personal or financial information to someone you did not ask to call you.
    • Ask the agent for the Division of Insurance (DOI) license number or National Producer Number (NPN),and verify that they are licensed to sell insurance in Massachusetts.
    • Know that calls from the Health Connector will only come from 1-877-623-6765. The caller will say, “We’re calling from the Massachusetts Health Connector.”
    • Insist on seeing a statement of benefits or a complete copy of the policy you’re considering. Make sure anything the salesperson told you about coverage is written in the statement of benefits. Legitimate plans should be willing to send you written information and give you the chance to check out their claims before you enroll. Be wary of salespeople who pressure you to sign up quickly.

  • Check the insurance carrier with the Massachusetts Division of Insurance (DOI).

    Only buy health insurance from a carrier that has a DOI license or is in a public program like MassHealth or Medicare. To check if a plan has a license, call the DOI Consumer Hotline at 617-521-7794 or review a list of plans here At Mass.gov: Download

  • Make sure the health plan meets Minimum Creditable Coverage.

    If a plan does not meet the state and federal minimum requirements for comprehensive coverage, you could owe a state penalty of up to almost $2,000 at tax time. Ask the health plan if they meet Massachusetts “Minimum Creditable Coverage.” If they say yes, make sure you get it in writing.

  • Understand what kinds of plans the website offers.

    When you shop for health coverage and you see these terms, know that these coverage types may not cover your costs for care or meet state and federal requirements:

    • Short-Term Health Plans
    • Health care sharing arrangements (also called sharing ministries)
    • Discount plans

Get the protection you need

Plans that meet state and federal requirements, including Health Connector health plans and health plans that DOI has licensed, will protect you in these ways:

  • Cover pre-existing conditions. These are health problems, like asthma, diabetes, or cancer, that you had before the date new health coverage starts.
  • Cover important Essential Health Benefits. These include preventive and mental health care, prescription drugs, and women’s care.
  • Limit your out-of-pocket costs. These are the amounts you pay out-of-pocket for care in a year.
  • Meet state tax requirements for comprehensive insurance. This is called Minimum Creditable Coverage.
  • Include state and federal financial help to lower your costs if you qualify. This is only for plans sold through the Health Connector.

Plans that meet state and federal requirements cannot:

  • Charge women more than men.
  • Limit the amount your insurance plan will pay for your care in a plan year or in your lifetime.
  • Charge you more or exclude coverage for pre-existing conditions.

Plans that don’t meet state and federal requirements don’t have these same rules. When you shop for health insurance, make sure you read the plan’s Summary of Benefits and Coverage and other coverage documents.

Find trusted coverage that meets all state requirements

Massachusetts residents have many choices for coverage that meet state and federal requirements and protections. Here are ways to shop safely for them:

  • Shop through the Health Connector at MAhealthconnector.org. Or call 1-877-MA-ENROLL (1-877-623-6765), or TTY 1-877-623-7773 for people who are deaf, hard of hearing, or speech disabled.

Shop directly with insurance carriers that the Division of Insurance (DOI) has licensed to sell Qualified Health Plans. You can learn more at the DOI website or by calling the Division at (617) 521-7794.

If you have questions about a health plan or insurance company

If you think you are the victim of a scam or if you have questions about a health plan or insurance company, call the Division of Insurance Consumer Service Section at 617-521-7794.

Or call the Attorney General’s Health Care Helpline at 1-888-830-6277 x 2. You may also file a complaint with the Division of Insurance or the Attorney General’s Health Care Division.

Massachusetts Division of Insurance official seal