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What You Need To Know About Healthcare Scams

Stethoscope on pile of moneyThe season for signing up for health insurance under the Affordable Care Act (Obamacare) is in full swing and unfortunately with it comes scams tied to Medicare. These scams have risen sharply over the course of the past year and beneficiaries of Medicare need to be on guard for swindles and to avoid unsolicited requests for personal financial information.

People are confused

The underlying problem is that the recent wave of publicity over the health care system and how it has changed has created confusion among many consumers. And of course with confusion, comes the opportunity for scamsters. But the fact is that there have been no changes in the open-enrollment procedure for Medicare. Unfortunately, about one in four Americans age 65 and over believes incorrectly that they can enroll in Medicare via one of the new state-based health insurance exchanges. However, these exchanges are only for people under the age of 65. Even worse about 17% of seniors over the age of 65 believe that the new exchange-based policies replace Medicare.

There has been healthcare fraud

A survey done of 1,101 people by Express Scripts discovered that 10% of the people who responded said that they or someone they know has been the victim of healthcare fraud. The way this works in most cases is that the con artist calls and falsely claims that the Affordable Care Act requires that people on Medicare buy new policies or a Medicare card. They often act as if they were representatives of Medicare or an insurance company and ask for Social Security or bank account numbers and other such personal financial information.

Medicare does not contact beneficiaries

If you or someone in your family is on Medicare, it’s important to know that as a rule that Medicare employees do not contact beneficiaries. Plus, Medicare rules prohibit most brokers, insurance companies and agents from initiating contact with people who are on Medicare.

They’e fishing for your personal information

If you receive an unsolicited call or visit, don’t divulge any information. If you are approached by someone who claims that they are from Medicare and need your personal information, you should file a complaint with the FTC (ftc.gov/ftc/contact/shtm), your local law enforcement agency, your state’s attorney general and your state’s insurance department.

Open enrollment has ended

Medicare’s annual open enrollment period ended on December 7. This was a time when beneficiaries could make changes to their coverage. So it’s probably too late for you to enroll or switch plans. However, if it’s critical that you make a change you could call 1-800- 633- 4227 and discuss your problem with someone woth the nonprofit State Health Insurance Assistance Program (SHIPtalk.org).

If you’re not on Medicare

If you’re less than 65 years of age and don’t currently have health insurance, you need to understand the following deadlines.

  1. December 23: The last day you can sign up for insurance coverage if you want it to begin January 1.
  2. February 15, 2014: The last date you can sign up for coverage without incurring a penalty for not having insurance. This penalty would be $95 or 1% of your taxable income, whichever is larger.
  3. March 31, 2014: This is when the open enrollment period for ACA insurance ends. If you wait until then, you may have to pay a month’s worth of the penalty for not having coverage. This penalty would be assessed when you file your 2014 taxes in April 2015.

Where you can get coverage

Most people will have to go to the troubled site healthcare.gov to sign up for their health insurance. However, if you live in one of the following states you can get your health insurance coverage through its exchange or what is often called a “marketplace.”

  • California
  • Colorado
  • Connecticut
  • District of Columbia
  • Hawaii
  • Idaho
  • Kentucky
  • Maryland
  • Massachusetts
  • Minnesota
  • Mississippi (SHOP)
  • Nevada
  • New York
  • Oregon (Cover Oregon)
  • Rhode Island
  • Utah (Avenue H—SHOP)
  • Vermont
  • Washington (Washington Health Plan Finder)

Be aware of a surge

Insurance companies are already struggling with applications for coverage that are error filled. The problem is that the technology fixes that have been made to healthcare.gov and that will allow millions of people to sign up for their health insurance have not totally addressed the faulty data that the site has been sending to insurance companies. These problems include enrollment forms with missing information, duplicate applications and erroneous personal information. There have even been cases where consumers thought they had signed up for insurance but don’t have a file with the insurer. While the insurance companies have been able to deal with these issues it’s largely because there has been a relatively low volume of people applying. But it’s believed that now the floodgates have been opened, the volume will grow dramatically. The health insurers say just don’t have enough people to handle everything manually. And they need “clean” enrollment files so they can process them by the December 23 deadline for people who want coverage to begin on January 1.

What are the biggest problems

The most serious problems faced by people who have enrolled for insurance through healthcare.gov is that they may find their subsidies have not been calculated correctly or that the insurance company with which they signed up wasn’t notified. The next most serious problem is people who lost their old insurance and have been unable to get through healthcare.gov to sign up for new plans.

How the state exchanges are working

As noted above, 18 states elected to form their own health insurance exchanges or marketplaces. Some of them have run into the same technical problems as healthcare.gov. As an example of this, in Vermont customers have been unable to pay for their plans due to technical problems. Hawaii’s site was not available until mid-October and consumers continue to report that it has problems. Oregon’s computer system can’t determine accurately whether or not people qualify for federal subsidies or Medicaid, forcing the state to hire 400 temporary workers to process thousands of lengthy paper applications until the problem is fixed.

In the District of Columbia and Colorado officials report that they have repaired major problems. Until recently, residents of Colorado who wished to see if they could get a federal subsidy to buy insurance through the state’s exchange had to go through a call center. Many people also complained that the application process was cumbersome and required them to apply for Medicaid then wait for a denial before learning whether they qualified for a subsidy..

On a brighter note

Several of the state-run marketplaces are functioning better than the federal exchange. Connecticut, Washington state and New York have marketplaces that are functioning fairly well. Customers have been able to login, register and enroll more quickly than on healthcare.gov.

What you need to do

If you live in one of the states that has its own health insurance marketplace you might want to get on its website and sign up for insurance before December 23 – assuming you want to have coverage beginning January 1. If not, you might wait until early February. It’s likely that by then your state will have ironed out any problems with its marketplace. If you don’t live in a state that has its own insurance marketplace, you will need to go to healthcare.gov to see if you can successfully sign up before December 23. Or you might also wait until early February to buy your health insurance as healthcare.gov should be running much better by then.

Would you qualify for a subsidy?

One of the most important parts of Obamacare is the subsidies designed to help people buy health insurance, which is what puts the affordable in the Affordable Care Act. If you will be required to sign up for health insurance, you need to know whether or not you would qualify for a subsidy. The simple answer is that subsidies will be available to individuals earning up to 400% of the federal poverty level or about $45,000 year. Families of four should be able to get a subsidy if their total income is $94,000 a year or less. If you would like a more detailed answer to this question, you could go the calculator that was developed by Kaiser Permanente and get an estimate of your eligibility for subsidies and how much you could spend on your health insurance.

How Obamacare will affect seniors

If you or someone in your family is a senior, here’s a graphic representation (Infographic) of how he or she will be affected by Obamacare.

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