As the Special Enrollment Period kicks off this week, the Division is concerned about plans that don’t provide sufficient benefits.
With the Special Enrollment Period (SEP) starting this week in Colorado, the Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA), encourages people who don’t currently have health insurance to take advantage of this time to enroll in individual coverage (meaning insurance that is not from an employer) that meets the robust benefit requirements of the Affordable Care Act (ACA). Getting covered provides access to health care, which is critical as we are still in the midst of the COVID-19 pandemic.
This SEP - here in Colorado it will be Feb. 8 to May 15, 2021 - is a time where people who do not currently have health insurance can enroll in individual insurance outside of the annual open enrollment period (which ended in January). The particular aim of this period is to help people who don’t have insurance due to the COVID-19 global pandemic, although anyone without health coverage can enroll.
However, as this enrollment period gets underway, the DOI is also cautioning Coloradans about people and groups that try to lure unsuspecting people into purchasing low-quality health insurance or health insurance-like products that DO NOT meet the requirements of the ACA and offer extremely limited coverage. These might be short-term plans, trade association plans, health care sharing ministries or other limited plans. Such plans can leave consumers stuck with huge medical bills from doctors and hospitals, as the plans deny and limit health care coverage in some or all of the ways below.
- Limiting coverage regarding the treatment for pre-existing conditions
- Limiting prescription coverage
- Limiting coverage for hospitalizations and emergency rooms
- Limited or no coverage for mental health / behavioral health treatment
- Limiting coverage for outpatient / same-day surgery
“My concern is the bad actors out there trying to dupe people into enrolling in these products, claiming they offer great coverage at super-low prices, all while burying the real details in the fine print,” said Colorado Insurance Commissioner Michael Conway. “I want people to be very careful about responding to unsolicited ads and sales pitches - whether those are online, over social media or on the phone. I want them to be careful about what personal information they share online when searching for plans. And if people are being harassed, I want them to file a complaint with the Division.”
What are the red flags that could indicate the health plan you’re looking at may fall short of the ACA requirements?
- High-pressure sales tactics
- Being told that the coverage is “just as good as the ACA.”
- Use of words such as “limited benefit plan” or “supplement plan.”
- Continued calls, emails, texts and even unannounced visits to your home by someone trying to close the sale. These may cross over to the level of harassment. If you believe you are being harassed, please file a complaint with the Division of Insurance (303-894-7490 / DORA_Insurance@state.co.us / doi.colorado.gov - click on “file a complaint”). It can help to stop these folks contacting you as well as prevent other people from being harassed.
How can you avoid buying this limited health coverage? Before you buy, ask for the plan’s details in writing, details such as how would the coverage work when visiting a doctor for tests and follow-up care, or how would the plan cover a hospital stay with testing, surgery and specialists. Know that you have the right to ask questions and get plan descriptions in writing. Ultimately, don’t feel rushed to make a decision, and don’t provide banking information or a Social Security number before you’ve had a chance to review the materials and get your questions answered.
Here are other questions to ask before buying.
- Is this a short-term, limited duration plan, a sharing ministry plan, or other limited-coverage plan? Is it sold through an association that requires a membership fee? If so, it could offer less coverage than an ACA-compliant plan.
- Is the person selling the plan licensed in Colorado? If so, ask for his/her state license number and contact the Colorado Division of Insurance at 303-894-7490 / DORA_Insurance@state.co.us to verify this license.
- What is the insurance company and is it licensed in Colorado? This can also be confirmed with the Division of Insurance.
- Does the plan cover your pre-existing conditions? Does it cover your prescriptions?
- What are the deductibles?
- What services doesn’t the plan cover?
- For services that are covered, how much will the plan actually pay? Is there a limit on the total amount the plan will pay per person, per service, or per year?
- Does the plan have a provider network of doctors, hospitals and other health care workers? If yes, ask for information about the network. Is your doctor or hospital in the network?
The DOI encourages Coloradans to shop for individual plans either through Connect for Health Colorado, with an insurance agent / broker they know and trust, or with a health insurance company directly. If you use Connect for Health Colorado, know that you can be connected to insurance brokers, assisters and Connect’s online resources to get help selecting a plan that can best meet your needs.
You can also view this list from the DOI - 2021 Individual Health Insurance Plans by County - to see which insurance companies are offering plans in your area, and how many plans they are offering. This list includes both information for on-exchange plans (meaning the plans are sold through Connect for Health Colorado, listed on pages 1-6) and information regarding off-exchange plans (plans sold through insurance brokers or from the companies directly, listed on pages 7-13). If you’re dealing with an insurance company NOT on the list, you are probably not looking at ACA-compliant coverage.
If you or a family member need help determining what kind of questions to ask when considering health insurance, or you just want some assistance decoding the language of a health plan, contact the Division of Insurance Consumer Services Team: 303-894-7490 / 800-930-3745 / DORA_Insurance@state.co.us. People can also visit our website - doi.colorado.gov - and look for our “For Consumers” information.
About the Division of Insurance:
The Colorado Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA), regulates the insurance industry and assists consumers and other stakeholders with insurance issues. Visit doi.colorado.gov for more information or call 303-894-7499 / toll free 800-930-3745.
DORA is dedicated to preserving the integrity of the marketplace and is committed to promoting a fair and competitive business environment in Colorado. Consumer protection is our mission. Visit dora.colorado.gov for more information or call 303-894-7855 / toll free 800-886-7675.