Protecting Yourself and Your Family
Consumers across the nation have been receiving phone calls and emails from scammers using the Patient Protection and Affordable Care Act (Affordable Care Act) to obtain personal information, commit identity theft and sell fraudulent health insurance.
Covered California takes consumer protection very seriously. Improper disclosure of consumers’ confidential information is a violation of federal and state law and is subject to fines of up to $25,000 under the Affordable Care Act. To help consumers protect themselves and their family from scammers, there are facts about Covered California and the changes coming to health care so that they can access new health care coverage options with confidence and trust.
Only the Covered California website is authorized to accept applications online. Other websites, or email-based enrollment, are not permitted at this time.
Deferred Action for Childhood Arrivals (DACA) individuals are not eligible to purchase insurance through Covered California and may be at a greater risk for being the victims of fraud. To verify eligibility and for more information on DACA and immigration, click here.
Top Tips: What Consumers Need to Know to Shop, Compare and Enroll With Confidence
Trust Covered California’s certified helpers. Many individuals and organizations are spreading the word about health care options, but only certified individuals are authorized to assist consumers with enrollment. Covered California’s Certified Enrollment Counselors are required to wear ID badges. If a consumer is approached by someone they do not know or trust, call Covered California at (800) 300-1506 to verify that they are certified.
Alert Covered California about suspected fraud. Call (888) 217-9309 or email email@example.com.
Enrollment assistance is always free. Never pay for help 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 and by calling the Service Center at (800) 300-1506 (interpretation is available in any language).
Consumers pay the health insurance company. Premium payment is between the consumer and their health insurance company — or a Covered California Certified Insurance Agent who is authorized to collect premium payments on behalf of an insurance company. Certified Enrollment Counselors cannot accept premium payments.
Shop and compare with confidence — and protect your information during enrollment. Covered California respects consumers’ privacy, so only limited, anonymous information — household size, income, ZIP code and the ages of enrollees — are needed to get an accurate estimate of coverage options from Covered California’s Shop and Compare Tool.
Consumers only need to provide personal information, like a Social Security number, when they are completing the actual online or paper application to enroll. Only helpers certified by Covered California are authorized to assist consumers with the application.
Health is personal. Consumers can’t be denied or charged more because of their health, so the application will not require information about health conditions, other than whether an individual is pregnant or has a disability. These are questions to see if consumers are eligible for special financial assistance programs.
Seniors in Medicare are not required to change their coverage or pay for new services under the new health care law.
If consumers accept enrollment assistance, they should always keep a record. If anyone offers to assistance with enrollment, write down their name; certification number; and the name, phone, address and website of the organization for which the individual works.
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.
Only individuals certified by Covered California are authorized to help consumers enroll (complete an application) in health insurance plans offered through Covered California. There are several kinds of individuals authorized by Covered California to provide enrollment assistance:
- Covered California Service Center employees.
- Covered California Certified Enrollment Counselors, including Navigators.
- Covered California Certified Insurance Agents.
- Covered California Certified Plan-Based Enrollers.
- County eligibility workers.
- Certified Plan-Based Enrollers.
In addition to certified individuals who can help consumers enroll, Covered California is also working with community organizations and educators to provide information about the new health insurance marketplace. Covered California Certified Educators will be at many public events and may approach consumers in person to ask if they are interested in health insurance. Certified Educators may take down their contact information so that Covered California can follow up to help them enroll; however, Certified Educators are not authorized to provide enrollment assistance (i.e., they cannot help a consumer complete the application for health insurance).
To verify that someone is certified by Covered California confirm whether they are a:
- Certified Educator (certified for education only, not enrollment assistance).
- Certified Enrollment Counselor.
- Certified Insurance Agent.
- Certified Plan-Based Enroller.
- County eligibility worker.
Write down the following:
- Individual’s full name.
- Individual’s Covered California certification number or, for agents, the California insurance license number.
- Name, phone, address and website of the organization for which the individual works.
- Over the phone at (800) 300-1506.
- Online for Certified Insurance Agents or for Certified Enrollment Counselors.
- For county eligibility workers, please contact the local County Human Services office.
Take All Precautions
If consumers accept enrollment assistance, they should always keep a record. If anyone offers to assist with enrollment, it is important to obtain their name; certification number; and the name, phone, address and website of the organization for which the individual works.
Payments and Money Management
If an individual is eligible for Medi-Cal, they may have free coverage.
A consumer should never pay for coverage with cash. Unbanked consumers should contact their health plan to learn how to safely pay their premiums. In general, when consumers enroll in a health insurance product through Covered California, they will be billed by their health insurance company directly.
If consumers receive premium assistance from the federal government to reduce their costs, they can choose to receive that support as a monthly advance that will be paid directly to the health insurance company so they pay less each month, or they can choose to receive less assistance each month and get the rest of the credit as a refund when filing their taxes. A consumer’s coverage does not begin until their health insurance company receives their first premium.
Certified Enrollment Counselors are prohibited from handling a consumer’s payment information. Certified Educators do not offer enrollment assistance and thus are similarly prohibited from handling payment information.
Certified licensed insurance agents and Certified Plan-Based Enrollers, who are employees of the health insurance companies, may be authorized to collect premiums on the health insurance company’s behalf.
Information for Enrollment
When consumers are ready to enroll, they will need to provide the following information:
The full name, date of birth and Social Security number of the individuals in the household that they seek to enroll in coverage.
For the primary applicant, proof that they are who they say they are (identity proof), such as a driver’s license or other ID.
Household income information. Most people will find it helpful to have their most recent federal tax return to gather this information, including any income from dependents. Social Security numbers of non-applicants may be requested, to verify income information, but alternative proof of income can be provided.
Their home address. If they do not have a home address, they are only required to provide a mailing address.
Information about which members of their household are going to be insured. To determine if an individual is eligible for special programs for mothers and infants, we will ask if anyone in their household is pregnant or has a disability.
Proof of satisfactory immigration status (citizenship or lawful presence).
Questions about Health Status
Health is personal. Consumers can’t be denied or charged more because of their health, so the application will not require information about health conditions, other than whether they are pregnant or have a disability. These are questions to see if consumers are eligible for special financial assistance programs.
Reporting Suspected Fraud to Covered California
To report suspected fraud, alert Covered California by completing the Complaint Form, calling (888) 217-9309, or by emailing us at StopFraud@covered.ca.gov. The Office of Integrated Fraud Management will track and investigate complaints and refer to law enforcement as appropriate. Identity theft is against the law and is punishable by imprisonment and fines.
Taking Action Against Scams
If consumers believe they have been a victim of a scam, they should alert Covered California to tell us how they were victimized by completing the Integrated Fraud Management Complaint Form. The Office of Integrated Fraud Management handles consumer and enroller fraud, waste and abuse. Please forward all matters or questions to the Integrated Fraud Management team at (888) 217-9309 or StopFraud@covered.ca.gov.
Covered California’s office of Integrated Fraud Management tracks complaints about any fraud connected with enrollment in Covered California and will assess, follow up and work with law enforcement as appropriate on a case-by-case basis.
Protect yourself! Consumers should learn immediate steps that they can take if they have been scammed and may be a victim of identity theft, including how to file a police report and alert your creditors:
California Office of the Attorney General checklist for identity theft victims: Victim Checklist
Federal Trade Commission information on identity theft: ID Theft. You can also call (877) ID-THEFT.
File a complaint with the Federal Trade Commission:
The Federal Trade Commission is specially tracking complaints related to the implementation of the health care law and will enter a consumer’s complaint into the Consumer Sentinel Network, a secure database that’s available to law enforcement agencies across the country. A consumer’s complaint helps them identify and take action against fraud. Visit the Federal Trade Commission website or call (877) FTC-HELP.
If the fraud consumers experienced or are concerned about involves an individual who says he or she is an agent or who is actively seeking to sell insurance, they can also call the California Department of Insurance’s Consumer Hotline at (800) 927-HELP.
If the fraud a consumer experienced or is concerned about is related to Medi-Cal, they can call the Department of Health Care Services Hotline at (800) 822-6222, email firstname.lastname@example.org, or fill out an online complaint form.
If somebody is approaching seniors enrolled in Medicare and trying to sell them a Covered California, Affordable Care Act or “Obamacare” insurance, it could be a scam.
For more information about how to protect yourself from scammers and shop and enroll with confidence, contact Covered California by calling (800) 300-1506.