Melanie Herrman is an insurance broker for Seasons Insurance Agency in Longmont. Recently, she received text messages claiming to offer new low-deductable, low-costs insurance plans. She warns that while these plans are not scams, they may not be what you think you are getting.
“I get a lot of complaints from people who get sucked into these types of plans because they don’t really cover what people think they cover,” Herrman said.
The plans she is referring to don’t follow the rules included in the Affordable Care Act such as covering preexisting conditions, maternity care, emergency room visits and ambulance services.
The plans are marketed to people as low-cost, low-deductible plans, often offered through text to individuals. According to Herrman, the plans can offer people health benefits but don’t cover a majority of health concerns, especially if the person has preexisting conditions.
Some of the red flags to look out for include describing the plan as a PPO plan or asking if you are healthy or have ongoing medical conditions.
These plans claim to be PPO plans or preferred provider organization plans. Colorado does not have any PPO plan available to individuals or families who have decided to buy insurance outside of an employer, Herrman said. PPO plans are offered through an employer’s insurance.
She said one of the ways to identify if you are being offered one of these plans is if they ask if you are healthy or have ongoing problems. Typically this is done to exclude conditions covered by the low-cost plan.
“That is generally a red flag to say that they are probably going to be excluding medical conditions if you have any,” Herrman said. “Make sure you read the document to find out exactly what is and what isn’t covered.”
What makes these plans concerning is that if they do not meet the needs of the person, it is impossible to change insurance plans outside of the enrollment period unless there is a “qualifying event,” Herrman said. Even with a qualifying event, a person has only 60 days to change plans.
“Otherwise you are kinda stuck for the year with a bad plan or without insurance all together,” Herrman said.
There are several ways people can make sure they are connecting with plans that work for them. Herrman suggests looking at Connect for Health Colorado, which is an insurance marketplace for Coloradans. This is also a good way to verify if the plans offered are “real” plans, Herrman said.
Another way is to contact an insurance broker who is trained and licensed to find insurance plans for individuals and families. Brokers can also explain offered insurance plans to you while identifying potential gaps in coverage, generally at no cost.
