Avoiding Fraud


How to Avoid Fraud When Buying An Individual Health Plan

The individual health insurance market consists of plans inside and outside the marketplace, which adds that much more confusion to the process of buying coverage — to most Americans, anyway. Now that coverage is mandatory, more people than ever before are shopping for health plans, and the individual market is the main outlet, especially as employer insurance has become less available and more costly in some cases. As plenty of personal information goes out over the course of a health plan application, it is in every policy seeker’s best interests to protect themselves from scam artists while looking for coverage.

As the government prepared for the rollout of the health insurance marketplace in October 2013, federal officials warned the public of the potential for fraud with the newly created plans. Especially because the introduction of new laws and health plans was lost on much of the nation, the White House increased awareness of scammers who may be posing as individuals working for the exchange, or false health insurance websites. The anticipated aim was gaining financial and personal information and stealing people’s identities.


Legitimate Health Plan or Scam?


Personal and Financial Information

According to the government, you shouldn’t trust a website that asks for your Social Security number, bank account number or credit card number, unless it’s Healthcare.gov. While this may be true, there are many online brokerages qualified to sell marketplace coverage, like East Coast Health Insurance. Because we’re a group of licensed agents selling plans nationwide, it seemed natural for our agents certified to offer exchange plans and be able to insure more people. When you fill out a health insurance application, you will have to provide your Social Security number to verify your identity and obtain medical information, but your financial information shouldn’t be collected until you’re approved, enrolled and ready to pay your premiums.



If you’re on Medicare, there’s no reason to buy health insurance anywhere else, because you legally cannot do so. Health insurance companies only sell individual plans to policyholders up to age 64, as the Medicare program accepts all Americans age 65 and older. If someone offers you coverage and you’re already enrolled in Medicare, they are not a health insurance broker.


Navigators and Application Counselors

The exchanges employ workers called navigators and certified application counselors to help people enroll in plans on the exchange. These workers are not health insurance brokers, and are only able to assist consumers with the application process. They cannot sell you a plan or make suggestions as to which plan you should purchase, and their services are free to shoppers. Therefore, if someone who says they are a navigator or certified application counselor recommends a plan to buy or or even asks a fee for their help, they are clearly not hired by the exchange.

Navigators and certified application counselors can ask for your SSN or other personal information, however. This is part of their job, and it doesn’t indicate a scam if they need the data to input into an application. Such workers should be clearly identifiable, as they will be working in a state-approved setting, such as a public library, hospital or health clinic.


Unsolicited Advertising

If anyone calls your home, sends you an email, or knocks on your door without you having contacted them first, inquiring about a health plan, don’t give them your account information. No one you contact from a health insurance agency has the time or indecency to knock on your door either, so rule the Jehovah’s Witness method out immediately. While this all seems fairly obvious, people do get ripped off all the time, and are especially prone in this era of mandatory insurance coverage mixed with the internet.


Health Information

As your health status is no longer a concern for health insurance companies, no one should ask for your personal health information. Under the ACA, insurers cannot increase your rates or decline you coverage for health reasons, so no one needs this data to enroll you in a plan. Navigators are not authorized to ask for this information.


The Individual Mandate

While it’s mandatory to carry a health plan, no one can send you to jail for being uninsured — the law basically states that if you can afford coverage you’ll have to buy a plan or pay a penalty. No health insurance agent or navigator will tell you you’re going to get locked up for not buying their product. This is yet another preposterous projection made by federal officials, but if people really don’t understand the law, it’s possible that some might fall privy to such claims.


The “Too Good to Be True” Rule

We all know the saying, “if it sounds too good to be true, it probably is.” It’s a sensible guideline for any kind of scam, but if you don’t know how much health plan cost to begin with, who’s to say you’ll be able to tell what’s a high or low premium? Always research before you agree to anything. In this site’s city section, we compare individual plan premiums in metro areas all over the country to show you what prices normally look like for certain age groups. You can research articles like these, or run a test quote for free to gauge your region’s average health insurance costs before believing that you can get insured for $20 per month, unless it’s a short-term plan.

Now that we’re all obliged to know about health insurance, it’s time to get educated! Scams only work on people who don’t know what they’re getting into, so it’s worth the time and effort to brush up on coverage and health reform before you buy — even from a legitimate source.

And, if you don’t completely understand the product you’re being offered, certainly do not sign anything.


Premium Rates

Another angle that scam artists could take is that premiums are only offered at a certain price for a limited time. Health plans are not going to go out of season or expire, nor be replaced by a next-generation version in two months. They remain consistent from month to month throughout the plan year. Premiums increase each year with inflation and medical costs, but this is no way related to being a limited time offer, unless you consider 12 months a limited time.

The only deadline to meet is getting a plan in place and effective by March 1. This effective date ensures you don’t get taxed for being uninsured that year.