Consumer Alert: Don't be fooled by claims of ACA-compliant look-alike health insurance products


Contact

Yeraldin Deavila
DOI PIO
775-687-0772
Carson City, NV - December 13, 2019

Open Enrollment is coming to an end on Sunday, and some consumers may find themselves pressured to enroll in health insurance before the deadline, making it easy to fall for misleading marketing practices from entities mimicking health insurance, such as plans offered by health care sharing programs or ministries (“HCSM”).

Consumers should be careful of purchasing plans from HCSMs; they may seem enticing because they may be cheap, look and sound like they are in compliance with the Affordable Care Act (“ACA”), when in reality these plans are not even insurance products. These plans are from organizations whose members share a common set of ethical or religious beliefs and have shared medical expenses in accordance with those beliefs.

Consumers should be aware of the following regarding health care sharing programs or ministries:

  • They do NOT comply with the Affordable Care Act (ACA), even if their materials say they do. If you come across any advertising or statements by a sharing program or ministry stating that it is ACA-compliant (or similar language), please report this to the Division of Insurance (Division).
  • Many sharing ministries specifically state that they do not guarantee payment for any health care and the member is ultimately responsible for anything the ministry does not pay. This language might be buried in the fine print, but it is an important notification.
  • They typically have restrictions or exclusions on pre-existing conditions, leaving the member responsible for the health care costs for those conditions.
  • Often such programs do not provide mental health coverage or substance use disorder treatment.
  • Members may also be subject to religious or moral restrictions from the sharing ministry, which may leave members responsible for the full costs of health care that results from an activity the ministry does not agree with.
  • Health care providers (doctors, hospitals) are under no obligation to accept or honor discounts from these programs if there is no contract or agreement to do so.

“There are many legitimate insurance products to choose from on and off the Exchange that have been reviewed and approved by the Division that offer full coverage and benefits in accordance with the ACA,” explained Insurance Commissioner Barbara Richardson. “Consumers should be aware of what they are purchasing so that they don’t find themselves without any financial protection during a time of sickness.”

With such products, there is no guarantee that claims will be paid and HCSMs are exempt from the ACA and state requirements. Please be aware that these programs are not regulated insurance products, which means there are no solvency standards or other regulatory protections.

Fortunately, there is still time to purchase health insurance that covers  the ten essential health benefits through Nevada Health Link, the online insurance marketplace operated by the state agency, Silver State Health Insurance Exchange – and the only place consumers can get financial assistance (subsidies) to help offset the cost of insurance.

Consumers can also purchase health insurance off the Exchange, but consumers cannot apply for any financial assistance. To view plans off the Exchange, please visit http://doi.nv.gov/Health_Insurance_Rates/Rate_Review/. These rates are displayed by age, county, and are for non-smokers. The search results are displayed and then sortable by plan name, carrier name, metal tier, and whether it is offered on or off the Exchange. It provides the full contracts and schedules of benefits as well.

If you believe someone is trying to sell you a health care sharing program or ministry by telling you that “it complies with the ACA,” or “is just as good as ACA plans,” contact the Division to let us know about these misleading marketing practices. If you're unsure of what kind of coverage you currently have, whether it is traditional health insurance, a health care sharing ministry, or something else, contact the Division to find out what questions to ask. Contact the Division by calling (775) 687-0700 or (888) 872-3234 or by visiting the website at http://doi.nv.gov/.

Open Enrollment ends December 15, 2019 at midnight.

About the Nevada Division of Insurance

The State of Nevada Division of Insurance, a Division of the Nevada Department of Business and Industry, protects the rights of Nevada consumers and regulates Nevada’s $14 billion insurance industry. The Division of Insurance has offices in Carson City and Las Vegas. In 2018, the Division investigated more than 3,100 consumer complaints and recovered over $8.4 million on behalf of consumers. For more information about the Division of Insurance, visit DOI.NV.GOV.  

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