How can I protect myself from fraud in the Health Insurance Marketplace?

When you apply for health coverage through the Health Insurance Marketplace, you can protect yourself from fraud by following a few simple guidelines.

Be informed about your health care choices

  • Spend some time with HealthCare.gov  to learn the basics about getting health coverage. It’s the official Marketplace website.
  • Compare insurance plans  carefully before making your decision. If you have questions, call the Health Insurance Marketplace call center at 1-800-318-2596. TTY users should call 1-855-889-4325.
  • Look for official government seals, logos, or web addresses on materials you see in print or online.
  • Know the Marketplace Open Enrollment dates. No one can enroll you in a health plan in the Marketplace until Open Enrollment begins or after it ends unless you have special circumstances.

Protect your private health care and financial information

  • No one should be asking for your personal health information, like your health history, any health conditions you have, or medical treatments you’ve received. Don’t give it to anyone.
  • Keep personal and account numbers private. Don’t give your Social Security number or credit card or banking information to companies you didn’t contact or in response to unsolicited advertisements.
  • Never give your personal health or financial information to someone who calls or comes to your home uninvited, even if they say they are from the Marketplace.

Ask questions and verify the answers you get

  • The Marketplace has trained assisters in every state to help you at no cost. You should never be asked to pay for services or help to apply for Marketplace coverage.
  • Ask questions if any information is unclear.
  • Write down and keep a record of the name of a salesperson or anyone who may assist you, who he or she works for, telephone number, street address, mailing address, email address, and website.
  • Double check any information that is confusing or sounds fishy. Check out HealthCare.gov to verify things or call the Marketplace at 1-800-318-2596. TTY users should call 1-855-889-4325.
  • Don’t sign anything you don’t fully understand.

When to report suspected fraud

It’s time to take action if:

  • Someone you don’t know contacts you about getting health insurance and asks you to pay – or asks you for your personal financial or health information
  • Someone contacts you and claims to be from the government or Medicare – and asks you to pay for a new “Obamacare” insurance card
  • You give your bank account information or Social Security number to someone who calls you and says they’re from the government

How to report suspected fraud

You can report suspected fraud one of 2 ways:

  • If you suspect identity theft, or feel like you gave your personal information to someone you shouldn’t have, use the Federal Trade Commission’s online Complaint Assistant.

    You should also contact your local police department.

    Visit www.ftc.gov/idtheft to learn more about identity theft.

  • Call the Health Insurance Marketplace call center at 1-800-318-2596. TTY users should call 1-855-889-4325. Explain what happened and your information will be handled appropriately.

HEALTH INSURANCE TERMS

Affordable Care act

The Affordable Care Act (ACA), sometimes called Obamacare, is a federal law designed to make health care more affordable, accessible and of higher quality.

COINSURANCE

The percentage of the bill you pay after your deductible has been met.

COPAY

A fixed amount you pay when you get a covered health service.

DEDUCTIBLE

The annual amount you pay for covered health services before your insurance begins to pay.

emergency care services

Any covered services received in a hospital emergency room setting.

health insurance marketplace (exchange)

The government Website (healthcare.gov) where you can purchase health insurance and see if you qualify for a tax credit (subsidy) to help pay premiums and out-of-pocket costs. 

in-network provider

A provider contracted by your insurance company to accept an agreed upon payment for covered services. 

OUT-OF-network provider

A term for providers that aren’t contracting with your insurance company. (Your out-of-pocket costs will tend to be more expensive if you go to an out-of-network provider.)

out-of-pocket

Your expenses for medical care that aren’t reimbursed by insurance, including deductibles, coinsurance and co-payments.

penalty

If you can afford health insurance, but choose not to buy it, you must have a health coverage exemption or pay a tax penalty on your federal income tax return.

premium

The amount you pay to your health insurance company each month. 


Preventive services

Health care services that focus on the prevention of disease and health maintenance.

rehab SERVICES

Services and devices to help you recover if you are injured or have surgery. This includes physical, occupational and speech therapy.

special enrollment period

The time after the Open Enrollment Period when you can still purchase health insurance only if you have a qualifying life event (losing other health coverage, having a baby, getting married, moving).

specialist

A physician who has a majority of his or her practice in fields other than internal or general medicine, obstetrics/gynecology, pediatrics or family practice.

SUBSTANCE ABUSE DISORDER SERVICES

Includes behavioral health treatment, counseling, and psychotherapy.

tax credit

Financial assistance from the government that helps those who are eligible pay for health insurance. Eligibility is generally determined by household income and family size.

Tiered benefit plan

A health care plan featuring multiple levels of benefits based on the network status of a particular provider.