It took nearly a year for Kelly Macauley to realize the health plan she bought while shopping for insurance coverage last October was not, in fact, insurance. Sure, red flags popped up along the way, but when she called to complain, she said, she was met with explanations that sounded reasonable enough and kept her paying her $700 monthly premiums.<\/p>\n

She said she was told that her medical bills weren\u2019t being paid because the hospital was submitting them incorrectly. That Jericho Share, the nonprofit that sent her a membership card reading \u201cTHIS IS NOT INSURANCE,\u201d was just her policy\u2019s underwriter, not the actual insurer. That she hadn\u2019t received a policy welcome packet because the company was saving paper and passing those savings on to customers.<\/p>\n

Then, this summer, the 62-year-old retired teacher who recently moved from the Philadelphia area to South Carolina, learned her plan had paid only $120 of the bill for her hip replacement last year, leaving her with a balance of over $40,000. She said she\u2019d been assured the procedure would be covered when she was shopping for insurance. But it turns out that the plan she purchased wasn\u2019t insurance at all but rather part of something called a health care sharing ministry.<\/p>\n

Health care sharing ministries are an alternative to health insurance in which members agree to share medical expenses. They are often faith-based and can be cheaper than traditional insurance, although they don\u2019t necessarily cover their members\u2019 medical bills, according to a Commonwealth Fund report<\/a>.<\/p>\n

\u201cThat was never, ever mentioned to me,\u201d Macauley said. \u201cI honestly believed I was buying legitimate medical insurance.\u201d<\/p>\n

Kelly Macauley thought she was buying health insurance when shopping for coverage online. It took nearly a year before she realized she had been sold a plan with something called a health care sharing ministry \u2014 an alternative type of coverage in which members agree to share medical expenses. \u201cI honestly believed I was buying legitimate medical insurance,\u201d she says.(Kelly Macauley)<\/span><\/figcaption><\/figure>\n<\/div>\n

Beginning Nov. 1, millions of Americans will purchase health insurance for 2023 in a period known as \u201copen enrollment.\u201d Through the federal<\/a> and state insurance marketplaces<\/a>, consumers can shop for Affordable Care Act-compliant health insurance plans and find out whether they qualify for financial assistance.<\/p>\n

But experts caution that the rush to buy coverage also presents an opportunity for people selling alternative products, such as short-term health plans and health care sharing ministries, that are often cheaper than comprehensive coverage but provide far fewer protections. Though those alternatives are themselves legal, experts caution that misleading marketing<\/a> can direct consumers shopping for comprehensive coverage into buying health plans that exclude protections for preexisting conditions and leave patients vulnerable to large medical bills.<\/p>\n

\u201cIt\u2019s a prime time to go looking for consumers who are out shopping for insurance and take them down the wrong path,\u201d said JoAnn Volk<\/a>, co-director of Georgetown University\u2019s Center on Health Insurance Reforms.<\/p>\n

Volk identified telltale signs of that wrong path: if the person selling you a plan starts asking about your health history, or if they refuse to send you information about the plan altogether, or they agree to provide that information only after you give them your payment information. According to a 2021 secret-shopper report<\/a> on misleading marketing practices, which Volk co-authored, one broker incorrectly cited HIPAA, the law to protect patient privacy, as a reason to not share information about the health plan.<\/p>\n

\u201cJust made-up stuff,\u201d Volk said. \u201cIf you\u2019re committing fraud, there are no boundaries.\u201d<\/p>\n

In a statement to KHN, Jericho Share spokesperson Mark Hubbard said the organization couldn\u2019t discuss Macauley\u2019s case without her prior written approval but doesn\u2019t tolerate any misrepresentation or unethical conduct on the part of its programs.<\/p>\n

Nationwide, lawmakers and regulators are taking notice of how health care plans are sold. Senate Finance Committee Chairman Ron Wyden<\/a>, a Democrat from Oregon, is investigating complaints<\/a> about the marketing of Medicare Advantage plans. And in May, the Centers for Medicare & Medicaid Services noted that complaints<\/a> about marketing practices for Medicare Advantage and Medicare prescription drug benefit plans rose from 15,497 in 2020 to at least 39,617 in 2021.<\/p>\n

\u201cScams involving health care have increased exponentially,\u201d said Delaware Insurance Commissioner Trinidad Navarro<\/a>, who also chairs the anti-fraud task force of the National Association of Insurance Commissioners.<\/p>\n

Multiple factors are causing the increase, Navarro said. Rising health care prices can drive up the cost of regulated health plans, such as those that are compliant with the Affordable Care Act. Higher costs push more Americans to look for cheaper alternatives that usually don\u2019t provide as much coverage<\/a> and can confuse consumers. Those types of plans proliferated under President Donald Trump\u2019s administration<\/a>, Navarro said.<\/p>\n

\u201cI don\u2019t want to sound political,\u201d said Navarro, an elected Democrat, \u201cbut the previous presidential administration was really pushing the skinny plans and the alternatives to the ACA, and I don\u2019t necessarily think that they understood the fraud that was associated with these plans.\u201d<\/p>\n