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By Liora Engel-Smith

As thousands of North Carolinians sign up for health insurance for next year, many of them may receive robocalls or encounter ads and websites for policies marketing themselves as being affordable, but which actually cover very little.

Websites with names like “Trump Health Care,” “Obamacare Plans” and “Provide Health Coverage” tout open enrollment, inviting consumers to search a variety of plans that may seem good on the surface. Upon closer examination, these plans have spending caps, exclude pre-existing conditions or don’t cover important services, such as prenatal care or prescription drugs.

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Related: It’s Obamacare season. Here’s what you need to know. [/symple_box]

Dania Palanker, an assistant research professor from Georgetown University’s Center on Health Insurance Reforms, said that though short-term insurance isn’t new, there has been an uptick in their aggressive marketing since the Trump administration relaxed the rules surrounding these plans.

A health insurance site that implies, but does not say directly, that the ACA was repealed.  “Trumpcare refers to health insurance under the Modified American Health Care Act – also known as the AHCA. The AHCA was the proposed replacement plan for Obamacare,” the site says right after it quotes President Trump saying “I want to have a great healthcare bill and plan – and we will. It will happen.”

Last year, the administration overturned an Obama-era rule that limited coverage of short-term health plans to 90 days. Unlike Affordable Care Act health plans, short-term plans can turn away people with pre-existing conditions. Short-term plans tend to be cheaper because they aren’t required to offer essential health benefits that Obamacare plans have to offer by law.

This change in rules has created a “wild west” that may fool consumers into buying plans that don’t cover their care, Palanker said.

Misleading advertising 

Searching for insurance coverage on some of these private sites yields an overwhelming, and often confusing, list of plans. In some cases, websites solicit personal information such as age, name, address, and pre-existing conditions, only to offer a list of other websites that link to other websites.

In one example, a search on Trump Health Care listed other websites. One of these sites, AdvantHealth, listed a short-term plan that costs $91.42 a month plus fees. The fine print on the page says the plan covers only two primary care visits a year and two specialist visits a year.

Another Advant plan goes for $88.49 a month plus fees but doesn’t cover prescription drugs. It also lists exclusions in excruciating detail, including that the plan doesn’t cover Friday or Saturday hospital stays when a surgical procedure is scheduled to be performed during the following week.

Some sites used blatantly misleading language that could trick consumers into thinking that they are looking at Affordable Care Act plans.

“Compare Affordable Health Insurance Plans Offered By Obamacare!” a banner on the website Health Insurance Online, said on Thursday morning. But searches on the site did not refer to Affordable Care Act plans or link to them. The banner, including the Obamacare logo, was later removed.

A screenshot of the website Health Insurance Online from Thursday morning. The banner that mentions Obamacare was removed from the site later that day.

Palanker studied marketing of short-term plans and found that websites for them often omit information consumers need to make a decision or provide misleading or incorrect information. In most cases, even consumers who use search terms like “ACA enroll” or “Obamacare plans” will be directed to such websites, she found.

Palanker said that state insurance departments regulate health care plans, including short-term ones, but their capacity is limited because of the large number of websites that in some cases don’t even originate in the state. The North Carolina Department of Insurance did not immediately respond to an inquiry Thursday on whether they’d fielded complaints about the misleading marketing.

Making matters even more complicated, Palanker added, are vague or confusing claims that aren’t quite lies.

A Facebook ad from Tuesday morning for Provide Health Coverage, a website that links to other websites selling short-term insurance plans.

“They won’t straight out lie but they’ll say ‘it’s open enrollment,’” she said. “Well, it is open enrollment but they don’t have an open enrollment period. They might say that they sell plans through major carriers, but that may be that they sell dental through major carriers.”

The right conditions?

The proliferation of short-term plan sites and ads also coincides with a decrease in federal advertising for the Affordable Care Act marketplace. The Centers for Medicare and Medicaid Services slashed its advertising budget for the Obamacare marketplace by 90 percent in 2017, and that budget remained the same this year. Much of that advertising campaign is aimed at sending reminder emails to people who enrolled in the marketplace in previous years, rather than reaching out to new consumers.

A Facebook ad for non-ACA insurance policy using a PBS news segment that quotes the president.

Though some organizations stepped in to fill that void, either by outreach or direct education, those efforts aren’t a match to the fusillade of ads and websites consumers may encounter. On Tuesday this week, the personal Facebook page of an NC Health News reporter showed at least 30 ads for sites and companies marketing non-ACA plans. Only one ad contained a link to the federal Affordable Care Act marketplace, Healthcare.gov. That ad was sponsored by the advocacy organization Young Invincibles.

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Several of the many health insurance marketing calls received by NC Health News editor Rose Hoban on her home line throughout fall, 2019.

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Erin Hemlin, director of health policy and advocacy at Young Invincibles, said many ads for short-term health plans specifically target young people because they are generally healthier and tend to use fewer services.

“In a lot of cases, [consumers who buy these plans are] young people who think they might be buying an ACA-compliant plan or plan that’s comprehensive and not going to discriminate based on gender, or health status or not deny them certain benefits and don’t realize until it’s too late that they actually bought a short-term plan,” she added.

Though short-term plans appear to offer lower premiums, some people could actually get a better rate on a basic Obamacare exchange plan if they qualify for federal subsidies. According to a Kaiser Family Foundation analysis, 4.7 million uninsured people nationwide could gain basic insurance coverage in 2020 on the Obamacare marketplace for free. More than half of them live in North Carolina, Texas, Florida or Georgia, the report found.

Short-term health plans are also the topic of some discussion among North Carolinians who are seeking coverage on the Affordable Care Act marketplace, said Mark Van Arnam, director of the North Carolina Navigator Consortium at Legal Aid of North Carolina.

The state has roughly 100 insurance navigators, he said, many of them volunteers, and they have been assisting as many consumers as possible. When consumers bring up short-term plans, Van Arnam said, navigators offer information about the difference between short-term and ACA plans. And if a consumer decides that short-term plans are the best choice, navigators will refer them to brokers and agencies who can help them, he added.

ACA enrollment ends this weekend and Van Arnam said navigators will hold events to help with last-minute signups.

In the absence of robust marketing from the federal government, these interactions are even more important, he added.

“[It helps consumers] be able to understand what’s really out there in the market and what’s the right choice for them.”

Liora Engel-Smith

Liora Engel-Smith joined NC Health News in July 2019 and covers policies, programs and issues that affect rural areas. She has previously worked for the The Keene Sentinel in New Hampshire and the Muscatine...