Press Release  Division of Insurance and Massachusetts Health Connector Warn Consumers to Use Caution When Shopping for Health Insurance Options during Open Enrollment

Boston — The Massachusetts Division of Insurance (Division) and Massachusetts Health Connector (Health Connector) are warning consumers looking to purchase a health plan during Open Enrollment to fully and carefully review any health plan to ensure it is compliant with both state and federal requirements. 

Open Enrollment, which runs from November 1, 2021 through January 23, 2022 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, or newly qualify for certain subsidies through the Health Connector. Consumers can purchase comprehensive health plans by contacting a licensed insurance carrier, through a licensed broker, or by going through the Health Connector, the Commonwealth’s official health insurance exchange.

The agencies issue this warning following an increase in complaints from consumers who unknowingly purchased an alternative to a comprehensive insured health plan or purchased a plan over the internet from a company not licensed to sell insurance in Massachusetts. Many of these plans do not comply with the Affordable Care Act (ACA) benefits or consumer protections standards, do not meet Massachusetts Minimum Creditable Coverage standards to comply with the state’s requirement to carry health coverage and avoid a tax penalty, and may not provide comprehensive payments for medical treatment and services.

“Many consumers in search for new coverage that meets their health and financial needs may be inclined to purchase a health plan that costs less than what they were previously paying. During Open Enrollment, and after any qualifying event, it is imperative that consumers take the necessary steps to verify that the product they are purchasing is going to provide them with the level and type of health coverage they and their families need,” said Commissioner of Insurance Gary Anderson.

“During Open Enrollment, the Health Connector offers quality coverage to everyone who needs it, and many people get help paying their premiums, making health insurance more affordable,” said Louis Gutierrez, the Executive Director of the Massachusetts Health Connector. “Solid health insurance provides not just access to care, but also peace of mind that costs are manageable. These other operators offer seemingly great rates, but in the end cover very little, meaning you are on the hook for potentially big medical bills, including paying full-fare for office visits, lab tests, and big procedures – and you may face a penalty at tax time for not carrying Minimum Creditable Coverage.”

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. The Massachusetts Health Connector can only be accessed by using http://www.MAhealthconnector.org/. Websites, including MassHealthPlans.com, Massachusetts-healthplans.com, and websites that reference “ObamaCare or ACA plans” may look like the state’s exchange but are not. These websites connect consumers with individuals, who may or may not be licensed insurance agents, in order to help sell other types of insurance or wellness plans, such as hospital indemnity insurance, limited benefit health plans, discount health plans, health care sharing ministries, or other non-comprehensive health plans. While many such plans may be legal, these do not offer the same consumer protections as a comprehensive insured health plan and will not guarantee payments for most medical services and expenses, and may result in a resident facing a tax penalty for not carrying Minimum Creditable Coverage.

There are 10 licensed insurance carriers approved to sell insured health plans to Massachusetts-residing individuals.  Over the past year, our offices have received inquiries and complaints about organizations such as Salvasen Health, Trinity Health Share, Multiplan/PHCS, BlackHawk Claims, CrowdHealth and National Association of Preferred Providers, none of which are insured health carriers, and in some cases are only access to networks of providers. 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 so consumers should be sure to ask whether the product they are buying is an insured health plan that is compliant with the Affordable Care Act.

When you are considering your options, you should take notes when you speak with an agent and ask the agent for their first and last name, as well as their NPN (national producer number) or their Massachusetts producer license number. Any individual who is unwilling to allow you to verify their credentials should not be trusted.  

You should read all the fine print when you are asked to sign anything. Even if you are signing up online, look for disclaimers on the website or policy documents such as “this is not insurance” or “does not meet Minimum Creditable Coverage.” Avoid being pressured into providing personal or financial information. In order to send you quotes, a legitimate insurance company only needs 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.

The easiest and safest way for Massachusetts residents to find affordable coverage that meets all state and federal standards for medical benefits and consumer protections is to shop through the Health Connector, which offers coverage through all of the state’s licensed medical carriers and is the only place where residents can qualify for state and federal subsidies to lower the cost of coverage.

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. A list of companies licensed to sell insurance to Massachusetts residents may be found here.

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

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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