Use Caution When Shopping Outside HealthCare.gov

Consumers can shop for 2020 health insurance coverage during the open enrollment period of November 1 to December 15 but, if they use enrollment pathways other than HealthCare.gov, they risk choosing subpar coverage and missing out on financial help for which they’re eligible in the marketplace.

HealthCare.gov and state-based marketplaces offer the gold standard shopping experience, where a consumer can see every plan offering comprehensive coverage in their area, determine their eligibility for financial assistance, and use various tools to compare premiums, cost-sharing, provider networks, and other metrics.

This year, consumers visiting HealthCare.gov can choose from an average of 38 plans, and 79 percent of marketplace consumers can buy coverage for less than $75 a month, after accounting for federal premium tax credits.

If, despite those advantages, consumers shop outside HealthCare.gov, they should:

• Avoid subpar plans that don’t comply with the marketplace’s protections. Insurers and brokers that sell coverage that doesn’t meet Affordable Care Act (ACA) requirements for marketplace plans will likely promote these plans during open enrollment. Consumers may see ads or other marketing for plans that don’t have to cover all essential health benefits, can deny coverage or charge higher prices to people with pre-existing conditions, and don’t cover medical services related to a pre-existing condition — but the ads won’t highlight those limitations. So-called “short-term” health plans will likely be the most common subpar product on offer, since federal rule changes now let insurers sell them for up to 12 months (in most states). Other subpar plans could include unregulated, non-insurance plans such as health care sharing ministries, direct primary care arrangements, and (in three states) Farm Bureau health plans. While these options might seem attractive because they offer lower premiums to certain healthier people, they could be inaccessible or unaffordable for less healthy people and may have gaps in benefits and limits on coverage that leave enrollees exposed to high out-of-pocket spending if they get sick. Consumers should be wary because some web screening tools can steer buyers to these plans if they click the wrong link.
• Investigate all plan options. “Direct enrollment” lets consumers enroll in marketplace coverage through a third-party web-based broker or insurer website. In some cases, consumers are redirected to the marketplace to complete their application but, increasingly, web-based brokers use the “enhanced direct enrollment” pathway in which consumers complete the entire enrollment process on their website. These brokers must comply with certain rules, but these websites give certain plans preferential treatment based on the insurer’s commission to the web-broker. In fact, some web-based brokers display nothing more than the name of a plan that doesn’t pay a commission, which means consumers can easily miss out on the plan that’s best for them. And insurers (as opposed to brokers) that use direct enrollment don’t have to show their competitors’ plans at all.
• Look out for sham marketplace websites. Some websites claim to be a “marketplace” but sell subpar or other plans that don’t qualify consumers for the financial assistance they could get by enrolling at HealthCare.gov. Instead of searching for insurance websites via a web browser, consumers should start at HealthCare.gov or their official state-based marketplace.
• Beware of a broker bait-and-switch. Consumers should be cautious in using websites that require them to enter their personal information for help over the phone: those websites are particularly likely to steer people away from comprehensive coverage and toward high-commission, non-ACA-compliant plans. Sharing personal information can subject consumers to aggressive marketing efforts or situations in which brokers push people to buy plans over the phone without disclosing the plans’ limitations in writing. Being required to answer questions about their health conditions or being shown a plan with dollar limits on certain benefits (such as a daily dollar limit on inpatient hospitalization) are red flags that a consumer was steered to a subpar plan.

HealthCare.gov and state-based marketplaces have valuable tools to compare and enroll in comprehensive, affordable coverage, and assistance is available from certified navigators or application counselors. Consumers shouldn’t be misled by deceptive and persistent marketing and miss the chance to enroll in a good-quality plan.