Consumers urged to be cautious buying health insurance online

AUGUSTA — The Maine Bureau of Insurance cautions consumers to be careful when searching for health insurance online for themselves and their families. This is especially important for Mainers who are shopping for coverage during open enrollment in Maine’s health insurance marketplace, which began Nov. 1.

A recent research study by Georgetown University found that when searching for affordable health insurance online, the results often show websites for lead generating companies at the top of the results lists. Lead generating websites ask for basic information and one’s phone number so an insurance agent can make contact, according to a news release from Karma Lombard with the bureau.

The study showed that consumers who receive calls after providing this information are often sold limited benefit insurance plans instead of major medical health insurance plans. There are crucial differences between these types of plans — major medical plans are traditional health insurance that cover preventive services, office visits, inpatient and outpatient services, and emergencies, while limited benefit plans only cover specific medical issues (e.g., cancer) up to a certain dollar amount.

Maine’s marketplace for individual major medical plans is CoverME.gov. CoverME.gov is Maine’s trusted, official state-run marketplace that works to ensure Mainers understand their health insurance options. The insurance companies that sell individual major medical plans in Maine are Anthem, Harvard Pilgrim/Point32, UnitedHealthcare, Maine Community Health Options and Taro Health (in certain counties).

Those looking for a major medical plan for oneself or family may purchase one of these plans through CoverME.gov or in some cases, directly from the insurance company. Be sure to type the correct website, as similarly spelled websites or websites ending in anything other than “.gov” will direct one away from CoverME.

One can call CoverME.gov at 1-866-636-0355; TTY: 711.

It is important to know what one is purchasing when buying insurance online or over the phone. Here are some potential red flags:

• The person on the phone won’t identify the name of their company;
• The person on the phone won’t provide their Maine license number;
• The consumer is not given the chance to review plan documents prior to purchasing the plan;
• The person on the phone insists that one must make their purchase right away or one will lose the deal;
• The consumer is told to pay a fee in order to purchase the plan; and
• One is told to join an association in order to purchase the plan.

In addition to limited benefit plans, there are products that look like insurance plans but are not. For example, health care sharing ministries are companies that collect contributions from members to create a sharing fund to help cover portions of other members’ health care costs. Health care sharing ministries are not insurance plans and do not guarantee that all claims for medical services will be covered. If a medical claim does not meet the sharing criteria for any reason, one will be responsible for the entire medical bill. If the ministry has spent what they collected, they may not be able to pay claims.

“If you purchase a non-regulated plan, the Bureau of Insurance may not be able to assist you if the company later does not pay claims as promised,” said Acting Superintendent Timothy Schott. “It is worthwhile to spend a little time and make sure that you are purchasing an authorized insurance plan from a Maine licensed company.”

There are also companies that may say they are selling health insurance when, in reality, it is just a scam to steal money from consumers and offer no coverage. This is another reason to be sure one understands who they are dealing with prior to giving any personal details either online or over the phone.

Additionally, only plans sold through the Maine marketplace are eligible for premium subsidies. The best way to ensure one is purchasing insurance instead of a non-insurance product is to make sure the company is authorized to sell insurance in the State of Maine. To look up licensed companies and insurance agents, visit maine.gov or can call the bureau office at 207-624-8475; TTY: 711 or 800-300-5000 (toll free) to see if a person or company holds a Maine insurance license.

Those worried that they have been redirected to a questionable website can write down the web address and call the Maine Bureau of Insurance before entering any personal or credit card information. Bureau of Insurance staff will be able to confirm whether one is in the right place to purchase a major medical health insurance plan.

Consumers with questions about insurance matters can obtain information and assistance from the Maine Bureau of Insurance by visiting maine.gov, calling 800-300-5000 (TTY call Maine Relay 711), or emailing insurance.pfr@maine.gov.