Fraud Alert: Shop for Marketplace Insurance with Caution

Beginning Oct. 1, 2013, health insurance consumers will be able to shop and enroll in new insurance plans through marketplaces on state or federal government websites. It’s part of the Affordable Care Act’s mission to provide universal health coverage. Coverage through the marketplaces, and an expanded Medicaid program, begins Jan. 1, 2014, which coincides with the date of the mandate to have insurance coverage.

What this means for your practice is that physicians should be well informed about upcoming changes in health insurance coverage, so they can make educated decisions about which new insurances their practice will participate in. What it means for healthcare insurance consumers is more affordable coverage options.

Be a Smart Shopper

But before you start shopping for health insurance, it’s a good idea to protect yourself from identity theft, scams, and other fraudulent activity. According to a Consumer Alert on the U.S. Department of Health & Human Services (HHS) Office of Inspector General (OIG) website, there are several ways you can become a victim of fraud in health insurance marketplaces:

  • People asking for money to enroll you in Marketplace or “Obamacare” insurance. Legitimate enrollment assisters will NOT ask for money.
  • High-pressure visits, mail solicitations, emails, and phone calls from people pretending to work for the government. No one should threaten you with legal action if you do not sign up for a plan. Always ask for identification if someone comes to your door.
  • People you did not contact who request personal information. They may be trying to steal your identity. No one from the government will call or email you to sell you an insurance plan or ask for personal identifying information. Be careful when giving out personal information, such as credit card, banking, or Social Security numbers.
  • Sham websites. Always look for official government seals, logos or website addresses.

Medicare beneficiaries don’t need to buy insurance in the Health Insurance Marketplace, so if someone is trying to enroll you in a plan, it’s a scam.

Learn More

Visit the official Marketplace website ( for more information.  The exchanges will offer a choice between four plans: Bronze, Silver, Gold, and Platinum, and the cost of premiums will depend on state, locality, and age. For an approximate cost of different plans, you can use Kaiser’s Health Insurance Subsidy Calculator.

Report marketplace consumer fraud by calling 1-800-318-2596.


OIG Consumer Alerts

Physicians Practice, “Health Insurance Exchange Information for Physicians, Patients,” Erica Sprey, Sept. 14, 2013


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