AUGUSTA – The Maine Bureau of Insurance cautions consumers to be careful when searching for health insurance online for themselves and their families.  This is especially important for Mainers who are shopping for coverage during open enrollment in Maine’s health insurance marketplace, which began on November 1st.

A recent research study by Georgetown University found that, when searching for affordable health insurance online, the search  results often show websites for lead generating companies at the top of the results lists.  Lead generating websites ask for basic information and your phone number so an insurance agent can contact you.  The study showed that consumers who receive calls after providing this information are often sold limited benefit insurance plans instead of major medical health insurance plans.  There are crucial differences between these types of plans – major medical plans are traditional health insurance that cover preventive services, office visits, inpatient and outpatient services, and emergencies, while limited benefit plans only cover specific medical issues (e.g., cancer) up to a certain dollar amount. 

Maine’s marketplace for individual major medical plans is CoverME.gov.  CoverME.gov is Maine’s trusted, official state-run marketplace that works to ensure Mainers understand their health insurance options.  The insurance companies that sell individual major medical plans in Maine are Anthem, Harvard Pilgrim/Point32, UnitedHealthcare, Maine Community Health Options and Taro Health (in certain counties).  If you are looking for a major medical plan for yourself or your family, you may purchase one of these plans through CoverME.gov or in some cases, directly from the insurance company.[1]  Be sure you type the correct website, as similarly spelled websites or websites ending in anything other than “.gov” will direct you away from CoverME.  You can call CoverME.gov directly at 1-866-636-0355; TTY: 711.

t is important to know what you are purchasing when buying insurance online or over the phone.  Here are some potential red flags for you:

• The person on the phone won’t identify the name of their company
• The person on the phone won’t provide you with their Maine license number
• You are not given the chance to review plan documents prior to purchasing the plan
• The person on the phone insists that you must make your purchase right away or you’ll lose the deal
• You are told you need to pay a fee in order to purchase the plan
• You are told you must join an association in order to purchase the plan

In addition to limited benefit plans, there are products that look like insurance plans but are not.  For example, health care sharing ministries are companies that collect contributions from members to create a sharing fund to help cover portions of other members’ health care costs.  Health care sharing ministries are not insurance plans and do not guarantee that all your claims for medical services will be covered.  If your medical claim does not meet the sharing criteria for any reason, you will be responsible for the entire medical bill.  If the ministry has spent what they collected, they may not be able to pay your claims. 

“If you purchase a non-regulated plan, the Bureau of Insurance may not be able to assist you if the company later does not pay claims as promised,” said Acting Superintendent Timothy Schott.  “It is worthwhile to spend a little time and make sure that you are purchasing an authorized insurance plan from a Maine licensed company.”

There are also companies that may tell you they are selling health insurance when, in reality, it is just a scam to steal money from consumers and offer no coverage.  This is another reason to be sure you understand who you are dealing with prior to giving any personal details either on line or over the phone. 

Additionally, only plans sold through the Maine marketplace are eligible for premium subsidies.  The best way to ensure you are purchasing insurance instead of a non-insurance product is to make sure you are working with a company authorized to sell insurance in the State of Maine.  You can look up licensed companies and insurance agents on our website here: https://www.maine.gov/pfr/insurance/licensee-search or you can call our office at 207-624-8475; TTY: 711 or 800-300-5000 (toll free) to see if a person or company holds a Maine insurance license.  Remember – if you are looking for a major medical plan, the best place to start is CoverME.gov online or by calling CoverME at 1-866-636-0355; TTY: 711.

If you are worried that you have been redirected to a questionable website, write down the web address and call the Maine Bureau of Insurance before entering any personal or credit card information.  Bureau of Insurance staff will be able to confirm whether you are in the right place to purchase a major medical health insurance plan. 

Consumers with questions about insurance matters can obtain information and assistance from the Maine Bureau of Insurance by visiting www.maine.gov/insurance, calling 800-300-5000 (TTY call Maine Relay 711), or e-mailing Insurance.PFR@maine.gov.

1] UnitedHealthcare only sells their individual and family health plans directly to Maine residents.

Maine Bureau of Insurance/Department of Professional & Financial Regulation
US Mail Address: 34 State House Station, Augusta, Maine 04333
Physical Address: 76 Northern Avenue, Gardiner, Maine 04345
Phone: (207) 624-8475 or 800-300-5000 (in Maine); TTY: Maine Relay 711
Email: insurance.pfr@maine.gov Web: www.maine.gov/insurance

Categories: Insurance

Tags: health insurance, Heritage Health Services, Insurance, Maine Bureau of Insurance