Unauthorized Health Plan Switching | Iowa Fraud Fighters

Individual health insurance is insurance you purchase yourself – not through an employer or provided through a government health insurance program. Individual health insurance policies come in two main forms –they are available either on or off the federal Health Insurance Marketplace.

If you are purchasing a policy that is on the federal Health Insurance Marketplace, you may receive help from a navigator, an assister, or an insurance agent certified to sell on the Health Insurance Marketplace. In Iowa for the 2024 plan year, three companies write policies on healthcare.gov: Wellmark Health Plan of Iowa, Oscar, and Medica. However, amidst the convenience lies unauthorized plan switching.

Unauthorized plan switching occurs when a healthcare plan and/or agent of record is changed without the explicit consent or knowledge of the consumer. While it may seem like an administrative glitch, it may be a form of fraud where the ramifications can be severe, leading to disruptions in healthcare coverage, unexpected medical expenses and may even owe additional taxes if a person unknowingly receives ACA tax credits.

The reasons behind the unauthorized plan switching are varied and may stem from system errors, or deliberate actions by rogue health insurance brokers or third-party entities to gain commissions. Regardless of the cause, consumers are left vulnerable and uncertain about their healthcare coverage.

Consumers must arm themselves with knowledge and take proactive steps to protect their interests. Here are some strategies to safeguard against unauthorized plan switching.

Regularly review your coverage. Periodically review your healthcare plan details on healthcare.gov. (Make sure you are using the correct website that ends in .gov, not.com.)  Verify that the plan selected matches your initial company and plan choice. Monitor for changes in your plan premium, deductible, and coverage benefits. If you receive mail or electronic correspondence from a different healthcare company this may be a red flag that a change has occurred without your knowledge. Report discrepancies promptly to your licensed insurance agent and healthcare.gov to seek assistance with resolving the problem.

Maintain records of all healthcare enrollment communications, transactions, and confirmations. This documentation will serve as evidence in case of a dispute regarding an unauthorized plan switch.

Secure your healthcare.gov account with a strong password, and avoid sharing sensitive personal information.

Switching also occurs when a consumer clicks on a Facebook or other digital ads and unknowingly consents to the change. The ad may have disclosures that allow the agent of record or plan to be changed. Be cautious when clicking on digital ads or other digital media related to health insurance.

Don’t answer your phone to unknown callers who may record a simple conversation then use the acknowledgment to change the plan or agent of record.

By staying vigilant, proactive, and informed, individuals can mitigate the risks associated with unauthorized plan switching. If you become aware of a plan switch, call your licensed insurance agent, contact Healthcare.gov at 1-800-318-2596 or go to their website to file a complaint. You may also file a complaint with the Iowa Insurance Division. The Division can work with the insurance company and healthcare.gov to attempt to resolve the problem. After researching, the Division may take administrative action against individuals who carry out these unauthorized switches.