Tuesday, December 12, 2017

Des Moines – The Iowa Insurance Division is warning consumers that companies may be offering health insurance policies that are fraudulently marketed or solicited by telemarketers as ACA-compliant plans.  Iowa Insurance Commissioner Doug Ommen encourages any Iowans interested in purchasing individual health insurance coverage to talk to a local licensed insurance agent or visit healthcare.gov by the end of the open enrollment period on Dec. 15.

“There are many types of policies being marketed to consumers that do not offer ACA-compliant coverage also known as ‘minimum essential coverage.’  These policies are not comprehensive medical coverage and will not exempt consumers from having to pay the individual mandate penalty.  Consumers should carefully read the description of benefits and out-of-pocket costs associated with any policy before making the decision to purchase a policy,” Ommen said.

Ommen offers the following additional guidance for consumers as open enrollment closes:

  • ACA-compliant individual health insurance plans are only available through healthcare.gov or directly from Medica in 2018.
  • Iowans who operate a business may also be able to join the small group health insurance market, but will need to consult with the appropriate advisors to establish an employer business organization.
  • Because ACA rates have risen so high, many consumers will be exempt from the ACA’s individual mandate in 2018.  If the lowest price premium under Medica exceeds 8.05% of a single individual’s income, consumers may wish to discuss the penalty with their tax adviser.  For example, a single 62 year-old in Des Moines would need an income of more than $178,000 annually to be assessed the shared responsibility penalty under the ACA’s individual mandate.  Consumers can learn more about the exemptions and how to apply at: https://www.healthcare.gov/health-coverage-exemptions/forms-how-to-apply/.
  • Policies that do offer short-term benefits, disability or specified disease benefits may not cover pre-existing conditions, or treatments that exceed the limited (90 day) term of coverage.  Consumers considering this option are advised to discuss the policy with an Iowa licensed insurance agent.  
  • Health-sharing ministries are not insurance, and consumers should very carefully read all materials before making a decision to participate.

Iowans with information about fraudulent marketing or solicitation of policies that are not ACA-compliant are encouraged to contact the Iowa Insurance Division at 877-955-1212 or online at https://iid.iowa.gov/insurance-consumer-complaint.