Pennsylvania Insurance Commissioner Advises Consumers to be Wary of Limited Benefit Plans, Exercise Caution When Shopping for Health Insurance

Friday, July 8, 2016 Health Insurance News J E 4

HARRISBURG, Pa., July 7, 2016 /PRNewswire-USNewswire/ -- Insurance Commissioner Teresa Miller today issued a consumer alert advising consumers to be cautious and understand the policy before purchasing a health insurance plan.

The Affordable Care Act created a federally-run health insurance marketplace located at, and subsidies are only available through the federal marketplace.

Health insurance plans can still be purchased "off-marketplace." These plans may advertise coverage at a lower rate, but they are not required to meet the same coverage standards as marketplace plans and may provide a more limited scope of benefits. Websites like may resemble the federal marketplace, but these are off-marketplace plans and are not eligible for subsidies. In addition, these plans may not protect you from tax penalties for not having minimum essential coverage.

"Providing tools to consumers that can help them make informed and empowered decisions about their health insurance has been a priority of the Insurance Department," said Commissioner Miller. "Off-marketplace products are still available, and like any other insurance policy, consumers need to understand these products and the coverage they offer before making a purchase."

Off-marketplace plans may advertise coverage at a lower rate than plans available through the federal marketplace, but these plans do not always offer the same level of coverage for routine medical visits, preventive care, and diagnostic testing. These plans are not required to provide coverage for pre-existing conditions, meaning you may have to pay for services related to pre-existing conditions out-of-pocket.

In addition, many of these plans have pre-designated reimbursement rates for types of services. For example, you could be reimbursed $200 for a trip to the emergency room and would be responsible for any remaining or extra charges.

Commissioner Miller urged consumers to consider the following questions when shopping for a health insurance plan, including:

  • Does the plan provide coverage for preventive, diagnostic, and other routine services?
  • Are your doctors in the plan's provider network?
  • Does the plan meet minimum essential coverage requirements? Will you receive a 1095 tax form?

"If your health insurance plan does not meet minimum essential coverage standards outlined in the Affordable Care Act, you may face a tax penalty," said Commissioner Miller. "Review your policy and understand its specifics so you can answer these questions. If you're unsure about anything, talk to your agent or contact the Insurance Department's Bureau of Consumer Services."

Consumers may contact the Insurance Department's Bureau of Consumer Services at 1-877-881-6388 or online at For more information on health insurance and how to shop for a plan, visit

MEDIA CONTACT: Ali Fogarty, 717-787-3289


To view the original version on PR Newswire, visit:

SOURCE Pennsylvania Insurance Department



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