Fraudsters are tricking homeless individuals into buying expensive ACA insurance 2023

Agents falsify health plan applications. Signees risk treatment interruptions and disqualification from further free and low-cost services.
Florida’s largest safety net hospital pharmacists stunned Mary Zhelyazkova by not filling her medication.

Zhelyazkova, 40, lived in a homeless shelter and needed opioid withdrawal drug Suboxone.

She reported she received free Suboxone from Jackson Memorial Hospital’s Ryan White HIV/AIDS Program.

At the end of 2021, a stranger on the street offered her $5 to sign up for a “free” Florida Blue health insurance plan. She claims she was told to lie about her salary and address to get coverage.

Zhelyazkova saw the drawbacks the next year.

Private insurance barred her from Ryan White. Florida Blue did not cover the hospital medication, so she had to drive to Walgreens, which required transportation. She could not afford the $20 copay.

I withdrew. “It was horrible,” said Zhelyazkova, who went without medicine for days until a charity needle exchange organization paid for it.

According to state insurance regulators, doctors, and enrollment counselors, commission-seeking agents and brokers have signed up hundreds of homeless Floridians for zero-premium health plans on the Affordable Care Act marketplace, including Zhelyazkova.

The premise is that dishonest salespeople and brokers sign up homeless persons for a sales commission and lie about their income and home locations.

The federal government covers the monthly premium for qualifying low-income consumers on an ACA plan, but the plans typically have copayments, deductibles, and other out-of-pocket charges that are prohibitive.

State and federal officials are investigating agents and brokers

For the fiscal year that ended Sept. 30, 2022, the federal agency that oversees the ACA marketplace received more than 25,000 complaints from people who claimed they were enrolled in policies without their consent or that an agent or broker submitted incorrect application information.

The Centers for Medicare & Medicaid Services also undertook over 700 licensing verifications to identify possibly problematic brokers throughout that time.

Florida, one of 10 states that have declined to expand Medicaid to virtually all low-income individuals, is expected to attract homeless people into ACA coverage. A 2015 North Carolina agent enrolled hundreds of homeless people in ACA coverage. Though not yet implemented, that state expanded Medicaid in March.

Medicaid would cover most poor single people in an expansion state. In non-expansion states like Florida, customers must earn at least 100% of the federal poverty level to qualify for health law tax credits, which lower monthly premiums and out-of-pocket expenditures. In 2023, a single person would pay $14,580 and a family of three $24,860.

A customer might nonetheless expect to earn enough next year to qualify for tax credits while having no income this year. If government data reveals previous income was insufficient, consumers do not need to demonstrate income on marketplace applications.

Sabrina Corlette, a Georgetown University health insurance policy specialist, said it appears homeless individuals are getting coverage. “That’s not bad,” she remarked.

However, it is not victimless. Health insurers support unqualified people with governmental subsidies. Homeless persons lose eligibility for better programs like hospital charity care and Ryan White. Corlette called it a major issue.