Protecting Our Consumers

Covered California wants you to enroll in health insurance with confidence. Our goal is to protect the rights of consumers by stopping unfair, deceptive and fraudulent business practices.

Authorized free assistance is provided by our Service Center employees, Certified Enrollment Counselors (also known as Navigators), Certified Application Counselors, Certified Insurance Agents, Plan-Based Enrollers and county eligibility workers.

Protect your personal information by keeping the following information in mind.

Top Three Fraud Schemes

Fraud is defined as providing false or misleading information to obtain a financial gain or other benefit. Fraud can occur when someone may not know that he or she provided false information, but reasonably should know that it was false.

  1. Upselling: Consumers are forced to purchase other products when they enroll in health insurance.
  2. Steerage: Consumers are enrolled into plans or metal plan tiers without explanation of all available options. Certified Enrollers and Certified Insurance Agents are required to provide information about all available health plans.
  3. Misleading websites appearing as Covered California: Consumers think they are shopping on Covered California’s official site. Websites certified to provide enrollment assistance will have the Covered California logo.

Top Tips

  1. Verify that an individual is certified by Covered California by calling (800) 300-1506 or visit Certified Insurance Agents and Certified Enrollment Counselors. Certified Enrollment Counselors are required to wear ID badges.
  2. Take all precautions. If you accept enrollment assistance from anyone, always keep a record. It is important to write down their name, certification number, phone number, address and organization’s website.
  3. Pay premiums only to the health insurance company you selected or to a Certified Insurance Agent.
  4. Never pay premiums with cash.
  5. Do not give out your personal information to someone you do not trust.
  6. Disclosure of consumers’ confidential information is a violation of federal and state law. Improper disclosure is subject to fines of up to $25,000 under the Affordable Care Act.
  7. There is no change for seniors in Medicare. Seniors are not required to change their coverage or pay for new services under the Affordable Care Act.
  8. Get informed. Learn the facts about Covered California, the Patient Protection and Affordable Care Act, and how to safely shop for your coverage options with us by exploring www.CoveredCA.com or calling (800) 300-1506.

How to Spot Fraud, Waste and Abuse 

FACT SCAM
Online enrollment is only allowed on www.CoveredCA.com. Monthly premium payments are made directly to the health insurance company through their website or to Covered California Certified Insurance Agents and Plan-Based Enrollers, who are employees of the health insurance companies. Online offer to help you enroll: A pretend official website asks you to enter your confidential information or make a payment.
Enrollment assistance from Covered California is always free.

Tip: Never pay for help in filling out the Covered California health insurance application. Enrollment assistance is available but is never required. Consumers can enroll directly on their own by clicking the “Apply” button at the top of this page.
Fee to enroll in Covered California: A consumer is charged for obtaining enrollment assistance.
Covered California certified representatives will never ask for cash payments.

Tip: Consumers without access to banks or other financial institutions should contact their health insurance company to learn how to make safe and secure payments.
Cash payments: Consumer asked to pay cash to enroll in coverage.
Consumers should never be denied enrollment assistance if they do not purchase supplement products that are offered.

Tip: Purchasing supplemental products is an option to the consumer. Seek different enrollment assistance at (800) 300-1506 if you are being pressured to purchase something you do not need. Interpretation service is available in any language.
Upselling: A consumer is pressured to purchase supplemental products as a requirement to purchasing health insurance through Covered California.
Individuals offering to explain your health coverage options through Covered California do not require confidential personal information in order to help you.

Tip: Consumers only need to provide personal information, like a Social Security number, when they are completing the Covered California online or paper application to enroll.
Cold calls or door-to-door tactics: Requesting your personal information.
Covered California does not use aggressive sales tactics.

Tip: There are no criminal penalties for failure to carry health insurance. Read more about the tax penalty.
Aggressive sales tactics: A salesperson uses aggressive sales tactics such as saying the government will send you to jail if you do not buy insurance or offers a one-time-only special discount.
Medicare recipients do not need to do anything to continue their coverage under the Affordable Care Act.

Tip: Call (800) MEDICARE ([800] 633-4227) to report scams.
Medicare recipients: A pressure caller requests your Social Security number and personal information to continue eligibility

Report Suspected Fraud to Covered California

Call: (888) 217-9309 (TTY: [888] 889-4500)

Email: StopFraud@covered.ca.gov

Or send a complaint form to:

Consumer Protection, Program Integrity Division
1601 Exposition Blvd.
Sacramento, CA 95815

Additional Fraud-Reporting Agencies

  1. Notify the following if you may be a victim of identity theft:

    File a complaint with the Federal Trade Commission: Visit the Federal Trade Commission website or call (877) FTC-HELP.

  2. For Agent or broker fraud, alert the California Department of Insurance’s Consumer Hotline at (800) 927-HELP.
  3. Medi-Cal fraud, call the Department of Health Care Services Hotline at (800) 822-6222, email stopmedicalfraud@dhcs.ca.gov, or fill out an online complaint form.