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State warns about ACA-compliant health plans amid misrepresentations

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Pennsylvania's top insurance official has a warning for residents seeking individual health coverage for next year: Make sure plans marketed as compliant with the Affordable Care Act actually are.

That's because some brokers have marketed plans as compliant when they were not, which can have costly results for consumers, the Department of Insurance said.

"We have taken action against seven agents in the past 20 months who misrepresented limited benefit plans as complying with the ACA," acting Insurance Commissioner Jessica Altman said.

Most were outside Central Pennsylvania — five were in the Reading area and one was in New Jersey. One was in York County: Cassandra Zangari, of Etters.

In July, a department consent order shows, Zangari reached an agreement with the department in which she admitted to misrepresenting to clients on at least three occasions that supplemental insurance policies were ACA-compliant. Among other violations, she also misrepresented clients' income so they would qualify for subsidies they were not otherwise eligible for, the order shows.

Signing a consent order meant Zangari agreed to waive her right to an administrative hearing and accepted the department's findings and conclusions. Her insurance license was revoked as a result.

A message left for Zangari Friday morning was not immediately returned.

Consumers who erroneously purchase non-compliant insurance plans could face tax penalties and possibly large medical bills, Altman said, as such plans may not cover pre-existing conditions or all of the minimum essential benefits required under ACA regulations.

Consumers can verify a plan is ACA-compliant by calling the insurance company directly, or through localhelp.healthcare.gov, insurance officials said.

Information on ACA open enrollment also is available at www.insurance.pa.gov, by clicking on "2018 ACA Health Insurance Open Enrollment" under key services. They also can  contact the Insurance Department's Bureau of Consumer Services at 1-877-881-6388.

Altman's warning comes at a critical time for those who rely on the plans, as this year's open enrollment window is shorter than in previous years. It opened on Nov. 1 and closes on Dec. 15.

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Roger DuPuis

Roger DuPuis

Roger DuPuis covers Cumberland County, health care, transportation, distribution, energy and environment. Have a tip or question for him? Email him at rdupuis@cpbj.com. Follow him on Twitter, @rogerdupuis2.

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Randyb November 13, 2017 9:47 am

ACA is dead, my plan doubled in price again for next year. It has self destructed all on its own by way of huge price increases. I can no longer afford it. Maybe a non-compliant plan is better, or at least affordable.

Warren November 13, 2017 9:30 am

Me and my daughter have been enrolled in a non-compliant health plan and have just renewed for the new year. These plans are much like the Pre-ACA plans... reasonable premiums, low deductibles and OOP and more widely accepted than the ACA plans...

My wife who has a preexisting condition had her pre-ACA coverage canceled... now she is paying twice her pre-ACA premium and twice what me and my daughter are currently paying. The provider network is smaller, deductibles are 5 tine what my plan has and the OOP are crazy. Her formulary doesn't include the one drug that helps her the most....

It is time to talk honestly about health care... Americans are great consumers, maybe the best in the world. How is it posable that so many believe a truly consumer based system would be a bad system?

Michael X November 12, 2017 10:03 pm

Great news. Where can we purchase these non-compliant plans? Our ACA compliant plan in Blue Bill is $2,936 per month ($35,233 per year), for a couple earning $70,000. If would be very helpful if Insurance Commissioner Jessica Altman would direct us to the non-compliant choices.

Deb C. November 11, 2017 10:22 am

I'm waiting until I can purchase what I want, not what I'm told I have to have.

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