Consumer Advisory: Division of Insurance reminds Coloradans that Health Care Sharing Programs do not comply with the Affordable Care Act
Buyer Beware: These programs are not ACA-compliant health insurance plans.
DENVER (May 31, 2019) – The Colorado Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA), is alerting Colorado consumers about the risks of health care sharing programs or ministries.
These programs may look and sound like Affordable Care Act (ACA)-compliant insurance, which can entice people to join, thinking that they’re getting the full coverage and benefits of ACA health insurance when they’re not. Such programs may even mimic the look and feel of ACA plans -- yet they do not offer the benefits of health insurance and certainly do not meet the standards of the ACA.
The DOI urges Colorado consumers to 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 DOI.
- 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.
“The costs for these health sharing arrangements are low because, when you look closely, they don’t cover much,” said Colorado Insurance Commissioner Michael Conway. “I’m concerned that people will only discover this when they’re at the hospital or when they get a bill for thousands of dollars. Ultimately, health care sharing programs may very well become the subprime mortgages of health care -- they look good up front, but there can be serious downsides to these products. I want to caution people so they understand what they are and are notbuying.”
Such programs are set up to avoid insurance regulation and do not offer people the consumer protections built into ACA-compliant insurance. And as they skirt insurance requirements, such arrangements leave people limited recourse for their complaints or for appealing denials of services or treatments received.
In recent months Texas, Georgia, New Hampshire, Washington and Nebraska have issued similar advisories to consumers, and in some cases, taken action against particular programs.
Bottom line: If it sounds too good to be true, it probably is. 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 DOI 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 DOI to find out what questions to ask.
For more information about consumer protection related to health insurance, visit AskDORA.colorado.gov and click the “health insurance” tab.
The Colorado Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA) regulates the insurance industry and assists consumers and other stakeholders with insurance issues. Visit dora.colorado.gov/insurance for more information or call 303-894-7499 / toll free 800-930-3745.
DORA is dedicated to preserving the integrity of the marketplace and is committed to promoting a fair and competitive business environment in Colorado. Consumer protection is our mission. Visit dora.colorado.gov for more information or call 303-894-7855 / toll free 1-800-886-7675.