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11/08/2017

Acting Insurance Commissioner Alerts Consumers of Individual Health Plans Not Compliant with Affordable Care Act

Harrisburg, PA - Acting Insurance Commissioner Jessica Altman issued a consumer alert for individuals to take extra care to confirm that individual health insurance plans sold outside of the federal Healthcare.gov website comply with the requirements of the Affordable Care Act (ACA), as open enrollment for 2018 continues through December 15.

“We have taken action against seven agents in the past 20 months who misrepresented limited benefit plans as complying with the ACA,” Altman said.  “These plans leave the consumers who bought them liable for a tax penalty for not having an ACA-compliant health plan, ineligible for tax credits for which they may qualify with a compliant plan, and often on the hook for large medical bills because the plans do not cover pre-existing conditions, or all of the minimum essential benefits that must be covered by ACA-compliant plans.”

Altman said consumers can check to see if their income makes them eligible for tax credits and subsidies to help pay for premiums and out-of-pocket costs by visiting https://pa.checkbookhealth.org.  All plans on the Checkbook website are ACA compliant.  Altman also reminded consumers that only plans bought on www.Healthcare.gov are eligible for subsidies.

Consumers who don’t qualify for subsidies should shop around to see if they can get a better deal by checking plans both on www.Healthcare.gov and those sold “off exchange.”  Off-exchange plans are sold directly by one of the five insurers offering individual health plans in Pennsylvania. These are Capital Blue Cross, Geisinger, Highmark, Independence BlueCross, and UPMC Health Plan.

“Consumers who choose an off-exchange plan should verify the plan they are buying complies with the ACA, includes coverage for pre-existing conditions, covers the minimum essential benefits required under the law, and will not leave them liable for a tax penalty for having a non-compliant plan,” Altman said.  

Consumers can verify a plan is ACA-compliant by calling the insurance company directly.  Anyone unsure if a plan meets ACA requirements can get help at www.localhelp.healthcare.gov.  Information on ACA open enrollment is also available at www.insurance.pa.gov, by clicking on “2018 ACA Health Insurance Open Enrollment” under Key Services.

Consumers can also contact the Insurance Department Bureau of Consumer Services at www.insurance.pa.gov, or 1-877-881-6388.

MEDIA CONTACT: Ron Ruman - 717-787-3289

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