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Q 104: Why is this a time to be especially on guard against health insurance fraud?

The health insurance reforms now under way as the ACA is implemented are bringing big changes. Few Americans are aware of all of the ACA requirements. Unfortunately, experience shows that during times of big change or confusion, fraud flourishes.

As the ACA is phased in, con artists posing as representatives of the federal government or as legitimate insurance agents, brokers, or navigators might try to steal consumers’ money or identities through various schemes. For instance, criminals might try to convince consumers to reveal personal information to receive a “national health insurance card” or a new Medicare card, or they might try to sell health insurance policies that are worthless.

Q 105: Can consumers get help from their current insurance agent or insurance company to buy health insurance coverage through Maine’s Health Insurance Marketplace?

Yes. Working with individuals known personally or known to be working for legitimate organizations is an important way to reduce the risk of fraud.

Q 106: If consumers don’t have a relationship with an insurance agent or company, where should they go for help?

When consumers contact Maine’s Health Insurance Marketplace, or type their zip code into the “Find Free Help” section of, they’ll be able to contact a navigator specifically trained to help them choose the best health insurance product for their needs.  Legitimate navigators will NOT charge a fee for assisting consumers. 

Q 107: How do consumers know that the insurance they’re being sold is what they need to comply with the law?

If consumers are buying a plan because the ACA requires them to have health insurance coverage, consumers should be sure they’re given a “Summary of Benefits and Coverage (SBC).” The SBC will indicate whether a particular insurance plan provides “minimum essential coverage.”

Q 108: If someone comes to consumers’ homes, calls consumers out of the blue, or sends emails to offer consumers health insurance coverage at a terrific price, how will consumers know whether the person and the health insurance coverage are legitimate?

Remember this simple formula: STOP – CALL – CONFIRM.

STOP – Consumers should ask the person for identification and a phone number where they may be reached later. If the person refuses to give this information for any reason, or tries to pressure them into signing any document, consumers should immediately hang up, close their door, or walk away.

Consumers should NOT volunteer their Social Security Number or a credit/debit card number to anyone unless they personally know the individual. Likewise, they should NOT sign any paperwork or write a check.

CALL – Consumers then should contact the Bureau of Insurance or Maine’s Health Insurance Marketplace. The insurance company or agent or broker, as well as the navigator, must be licensed or certified by the Maine Bureau of Insurance before they can sell coverage or counsel consumers through Maine’s Health Insurance Marketplace.

CONFIRM – Consumers should always confirm that the company, agent, or broker offering insurance coverage, or the navigator trying to provide assistance, is authorized to provide information or coverage before they sign any documents or give any personal information.

Remember that if something seems too good to be true, it usually is.

Last Updated: October 4, 2013