Press Release  Division of Insurance and Massachusetts Health Connector Warn Consumers to Be Wary of Unlicensed ‘Health Plans’ and Limited Benefit Plan Options during Open Enrollment

Boston — It’s Open Enrollment and the Massachusetts Division of Insurance (Division) and Massachusetts Health Connector (Health Connector) are reminding consumers to carefully and fully review health coverage options and understand how they work before rushing into purchasing a health plan.

Open Enrollment, which runs from November 1, 2020 through January 23, 2021 for Massachusetts residents, is the period when consumers can start, stop, or change their health insurance coverage for any reason.  During the rest of the year, consumers can only enroll in or change their insurance if they have a qualifying event, such as getting a divorce or losing a job. Consumers can purchase comprehensive health plans by contacting a licensed carrier, through a licensed broker, or going through the Health Connector, the Commonwealth’s official health insurance exchange. However, consumers in search for new coverage that meet their health and financial needs are sometimes finding less trustworthy options through internet searches and purchasing a plan without reading the fine print.

“During Open Enrollment and as the COVID-19 public health crisis continues, it is imperative that consumers take the necessary time to find an appropriate health insurance plan to ensure that coverage is in place if the unexpected occurs,” said Commissioner of Insurance Gary Anderson.

“Having health insurance that works by providing access to vital services is more important than ever as we battle COVID-19,” said Louis Gutierrez, the Executive Director of the Massachusetts Health Connector. “The Health Connector was designed to provide a trustworthy and easy-to-use marketplace for residents to shop from safe, vetted, high-quality health coverage that will be there for people when they need it. All Health Connector plans meet state standards, giving our members peace of mind that the coverage they find is not only affordable, but delivers access to care.”

Limited benefit health plans and plans purchased from an unlicensed insurance company do not comply with the Affordable Care Act (ACA), do not meet Minimum Creditable Coverage requirements, and typically do not provide comprehensive payments for medical treatment and services. Consumers should also use caution when considering alternatives to comprehensive health insurance plans, such as hospital indemnity insurance, discount health plans or health care sharing ministries, since these plans, while legal, do not offer the same consumer protections as a comprehensive health insurance plan and may not guarantee payments for medical services and expenses.

Whenever looking for a new health insurance plan, consumers should:

• Be careful when looking at other websites when you are trying to learn about comprehensive health coverage available through the Health Connector. There are many websites on the internet that intentionally resemble the Health Connector’s website. Even if you don’t purchase a plan from one of these mimicking sites, consumers report being inundated with sales calls and text messages after providing their contact information. The Massachusetts Health Connector can only be accessed by using http://www.MAhealthconnector.org/. 
• Look for disclaimers on the website or policy documents such as “this is not insurance” or “does not meet minimum creditable coverage.” Take notes and ask careful questions of any agents with whom you speak. It is a violation of the state’s insurance consumer protection laws for a licensed agent or company to knowingly mislead or misinform a consumer about the product they are looking to purchase.
• Always take a close look at plan benefits and limitations before you sign up or pay any fees. That way you can see in advance if the plan is right for you and your family. Remember to add up how much you will have to pay out of your pocket for deductibles and co-payments and items that are not covered. High out-of-pocket costs can soon wipe out the savings of lower monthly premiums. The National Association of Insurance Commissioners’ (“NAIC”) Health Insurance Shopping Tool helps easily compare different health insurance policies. More information can be found here: https://naic.org/documents/health_insurance_shopping_tool.pdf
• Avoid being pressured into providing personal or financial information. Legitimate insurance companies are very limited in what information they can ask of you.  In order to send you quotes, they only need to know your name, age, and contact information and whether you are looking for coverage for just yourself or if you have family members who would also be covered by the plan.  They cannot ask questions about your medical history, such as whether you have pre-existing conditions or what prescriptions you might be taking.

For information on purchasing a health insurance plan from the Health Connector, please call 1‑877-MA-ENROLL or visit www.MAhealthconnector.org.

Consumers with questions or concerns about the legitimacy of a health insurance plan or company are urged to visit the Division’s website at www.mass.gov/doi, or to contact the Division’s Consumer Services Unit at (617) 521-7794 or by email at CSSComplaints@mass.gov.

About the Division of Insurance

The Division of Insurance is an agency within the Office of Consumer and Business Regulation. The primary mission of the Division is to monitor the solvency of its licensees in order to promote a healthy, responsive and willing marketplace for consumers who purchase insurance products. The Division is responsible for regulating Massachusetts’ $60 billion insurance industry and overseeing more than 1,600 licensed insurance companies and approximately 141,000 individual insurance producers.  Protection of consumer interests is of prime importance to the Division and is safeguarded by providing accurate and unbiased information so consumers may make informed decisions and by intervening on behalf of consumers who believe they have been victimized by unfair business practices.

About the Massachusetts Health Connector

The Massachusetts Health Connector is the Commonwealth’s health insurance exchange, and currently serves 318,000 individuals and small-employer members with health and dental insurance. Massachusetts residents who do not have health insurance from an employer or other entity can use the exchange to gain coverage. Through the ConnectorCare program, income-qualifying residents can access coverage that includes low-cost premiums and co-pays, and no deductibles. Access to health coverage for individuals and small businesses can be found at the Health Connector’s website, www.MAhealthconnector.org.

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