Caution urged when choosing health care plan

Posted

DOVER — Delaware Insurance Commissioner Trinidad Navarro is urging Delawareans to be careful when buying a plan through the Marketplace to make sure they select one that provides adequate coverage and meets the requirements of the Affordable Care Act.

While the special enrollment period, which began Feb. 15, is a good time to enroll in an insurance plan, noncompliant off-Marketplace plans may be heavily advertised during this period and may appear attractive, despite often being more expensive and far less comprehensive.

Short-term limited benefit health insurance, for instance, covers only a set number of doctor visits for a limited dollar amount and may have very high deductibles and copay requirements. These plans do not qualify for or replace a major medical, ACA-approved health insurance policy, and policies are only effective for three months and are not renewable.

Other plans may lack coverage of critical needs, thus putting consumers at risk of significant medical bills.

Non-insurance products like health care sharing ministries are not regulated and as such are not required to cover a person’s needed care. Trade association plans and other limited plans can offer low-quality coverage that does not meet ACA standards and may not meet a consumer’s needs. None of these plans offer the financial subsidies and tax credits of ACA plans, which about 86% of Delaware enrollees are eligible for.

While the Delaware Department of Insurance has not seen significant increases in fraudulent contact or limited benefit plan sales, the pandemic has emboldened bad actors who aim to capitalize upon unusual circumstances, including the Special Enrollment Period.

The Special Enrollment Period will allow Marketplace enrollment through May 15 on HealthCare.gov. Individuals who are uninsured, regardless of the reason for their lack of insurance, can enroll during this period. Existing Marketplace participants have the option to move to another plan.

Local coverage navigators are available to direct consumers to appropriate plans. Visit the Choose Health DE website to get connected to a local navigator or call 800-318-2596.