Consumer Advisory: Division of Insurance Cautions Coloradans on the Limitations of Health Care Sharing Programs
These programs can leave you stuck with huge medical bills.
DENVER - As open enrollment for individual plans (meaning not from an employer) continues, the Colorado Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA), is again alerting consumers about the risks of Health Care Sharing Programs or Ministries.
On the surface, such programs may look like complete, Affordable Care Act (ACA) insurance. Low monthly payments, which the programs may refer to as “premiums,” may entice people to join, thinking they’re getting full health insurance coverage at a bargain. Such programs may even mimic the look and feel of ACA-compliant health insurance, using terms like “bronze, silver and gold tiers.” But these sharing programs or ministries often do not offer the same comprehensive benefits as ACA plans, and do not meet the ACA consumer protection standards.
Problems occur when members get medical care and then these programs don’t pay, leaving the member with the doctor and hospital bills. The member is surprised as they thought they had full insurance coverage, but come to find out all that these programs don’t cover.
If you are enrolled in one of these programs and are now having problems - like not getting your claims paid - please contact the DOI’s Consumer Services Team to see if we can provide assistance: 303-894-7490 / 800-930-3745 / DORA_insurance@state.co.us / doi.colorado.gov.
The DOI urges Colorado consumers to be aware of the following before signing up for a health care sharing program or ministry.
These programs typically have restrictions or exclusions on pre-existing conditions, leaving the member responsible for the health care costs for those conditions.
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.
Often such programs do not provide mental health coverage or substance use disorder treatment.
All of which means that health care sharing programs or ministries DO NOT comply with the Affordable Care Act (ACA) coverage requirements, even if their materials imply 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’s Consumer Services team at 303-894-7490 / 800-930-3745 (outside of the Denver metro area) / DORA_insurance@state.co.us.
“I’m worried that many people will only find out about what these programs don’t cover when it’s too late - when they’re already at the hospital or when they get a large bill in the mail,” said Colorado Insurance Commissioner Michael Conway. “Up front, these programs look like they can save you money, but the costs to a consumer on the back end will not only be surprising, but also a serious financial blow. People need to understand the limitations of these products, especially in the midst of pandemic.”
Open enrollment for full, ACA-compliant individual plans continues here in Colorado until Jan. 15, 2021, although to have coverage in place by Jan. 1, you need to be enrolled by Dec. 15. While health care sharing programs or ministries may look attractive, they very often are a case of “too good to be true,” as they can ultimately leave you with health care bills that will negate any savings you expect. The DOI encourages Coloradans to shop for individual plans through Connect for Health Colorado. There, people can find help through insurance brokers, assisters or Connect’s online resources in selecting a plan that can best meet their needs.
If someone is trying to sell you a health care sharing program or ministry by telling you that “it is just as good as an ACA plan” or “it complies with the ACA,” contact the DOI Consumer Services Team to let us know about these misleading marketing practices. Please also contact us if you are currently enrolled in one of these programs and are struggling to have your claims paid. If you're unsure of what kind of coverage you currently have, whether it is a traditional health insurance, a health care sharing ministry, or something else, you can contact us to find out what questions to ask.
Contact the DOI’s dedicated Consumer Services Team:
Or visit our website - doi.colorado.gov - and look for our “For Consumers” information.
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About the Division of Insurance:
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 doi.colorado.gov for more information or call 303-894-7499 / toll free 800-930-3745.
About DORA:
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 800-886-7675.
