Individual health insurance is insurance that you purchase on your own, not through an employer or through a government health insurance program. Individual health insurance policies come in two basic forms - they are available in the federal health insurance marketplace or outside of it.
If you are buying a policy on the federal health insurance marketplace, a navigator, assistant or insurance agent certified to sell on the health insurance marketplace can help you. In Iowa, three companies write policies on healthcare.gov for 2024: Wellmark Health Plan of Iowa, Oscar and Medica. Hidden among the conveniences, however, is unauthorized plan switching.
An unauthorized plan change occurs when a health care plan and/or enrollment agent is changed without the consumer's explicit consent or knowledge. While this may seem like an administrative error, it can be a form of fraud, the consequences of which can be serious, leading to disruptions in medical care, unexpected medical expenses, and even additional taxes if a person unknowingly receives ACA tax credits.
The reasons for unauthorized plan changes are varied and may be due to systemic errors or intentional actions by unscrupulous health insurance brokers or third parties to generate commissions. Regardless of the cause, consumers remain vulnerable and uncertain about their health insurance coverage.
Consumers should arm themselves with knowledge and take proactive steps to protect their interests. Here are some strategies to protect against unauthorized switching.
Check your coverage regularly. Periodically review your health plan information on healthcare.gov . (Make sure you are using the correct website, which ends in .gov, not .com). Make sure the plan you choose matches your original choice of company and plan. Keep up with changes in premiums, deductibles and benefits. If you receive mail or email correspondence from another health care company, it could be a red flag that changes have occurred without your knowledge. Immediately report discrepancies to your licensed insurance agent and to healthcare.gov for help in resolving the problem.
Keep a record of all communications, transactions, and confirmations of enrollment in the health plan. This documentation will serve as evidence in the event of a dispute about an unauthorized switch to another plan.
Protect your healthcare.gov account with a strong password and do not share sensitive personal information.
Switching also occurs when a consumer clicks on an advertisement on Facebook or other digital services and unknowingly agrees to the change. The ads may contain information to change enrollment agents or plans. Use caution when clicking on digital ads or other digital media related to health insurance.
Don't answer calls from unfamiliar callers who may record a simple conversation and then use the confirmation to change the plan or recording agent.
By being vigilant, proactive, and informed, people can reduce the risks associated with unauthorized plan switching. If you become aware of a plan switch, call your licensed insurance agent, contact Healthcare.gov at 1-800-318-2596, or visit their website to file a complaint.