For as long as I can remember, when I worked full-time office jobs I signed up for employer-based health insurance plans that were offered to me. They generally served me well, I had very few issues with the insurers, and the premiums were reasonable for the type of coverage I wanted.
In 2019, though, I became a "free agent." And after going for several months without a health insurance plan, I decided I needed to explore my options because I wasn't getting any younger and was trying to stay regular with my yearly check-ups, mammograms, etc.
I tried the private health insurance route but that didn't work. So my only other option was the health insurance marketplace, otherwise known as "Obamacare."
I've been on a marketplace-based health insurance plan since 2020, and paid the full premiums 2020-2022, but in 2023 and 2024 I qualified for the subsidy due to the astronomical rise in the cost of marketplace plans. For those who don't use the marketplace to get their health insurance, an explainer: when you qualify for the subsidy, you have the option to either just use part of it or all of it.
Because the premiums were so high, I chose to use all of it for both years. But it was this year that I ran into problems that I found out very recently were the result of unscrupulous brokers.
I've never used a broker to sign up for a plan through the marketplace. Navigating the site is pretty easy (here in NC, you go to the healthcare.gov site, NC does not have/run its own ACA marketplace site, as far as I know).
But a few days ago when I went to the site to double-check to make sure all my information was correct ahead of open enrollment for 2025, I found something odd: an eligibility letter from May of this year. The only eligibility letter I should have had was from early December 2023, when I signed up for my plan and healthcare.gov in turn sent me the letter letting me know if I qualified and if so for what amount.
After speaking with an extremely helpful marketplace agent Friday I found out that two different brokers basically hijacked my account, one in December, about a week after I originally signed up, and another in May of this year.
Suddenly, it all made sense because in late December after I paid my first premium for the new year I got a revised invoice from my insurer essentially telling me I had a premium of less than $15 a month now (down from nearly $200!) because my Obamacare tax credit had been increased.
When I called my insurer at the time to find out why, they said the change was sent from the marketplace and that it was likely they'd found more ways for me to save money. So I didn't question it beyond that. I kept telling myself this had to be too good to be true - and as it turns out, it was.
What actually happened, as I found out last week, was that the first unauthorized broker who accessed my account - which come to find out is quite easy for a rogue broker to do - changed my estimated income on the application to a lower amount, which is what made my tax credit go up to the point I had a very small premium. They also changed my email address so I would not get notified of the change at the healthcare.gov site.
The second broker (who accessed my account in May) made no income changes but for some reason, my tax credit went up even more to the point I had no premiums. I got new cards at the time, though, which should have sent up red flags. But considering I had a million things going on at the time (like the massive crawlspace project, for example, and doctor's appointments for Mom), I didn't call to ask why.
Long story short, because that broker changed my estimated income to a substantially lower amount, I was getting more of a tax credit (APTC) than I should have. Though I went in over the weekend and "fixed" the estimated yearly income to what I think it will be at year-end, the damage for the first 9 months of the year has been done. As a result, even if the fraud investigation conclusively shows what happened, I still may have to pay back a painful chunk come tax time, depending on how they compute and configure everything.
Things I've already done to better protect my account: activated the two-step authentication process, which is something I understand is relatively new to Obamacare in response to the brokers who were so easily able to access someone's account.
Also, I've got a monthly reminder now to check the healthcare.gov site (NOT my insurer's site) to see if there is an eligibility letter more recent than the one generated specifically in response to the application I filled out (to know this, check the date on the letter - if you didn't do anything on the application on that date, someone else has made changes to your application without your consent).
If that has happened, check it over for any relevant changed information - especially the estimated income. Also check for changed contact information like phone numbers, addresses, and email addresses. Fix them.
And even if there is no change in the income, report it to the marketplace immediately so they can start a fraud investigation. They will likely tell you to resubmit an application noting on it that no broker helped you with your plan. That way, the rogue broker can be taken off your account as soon as your insurer gets the new information. At that time, the broker no longer gets a commission from having you as their "client."
Lastly, if all else fails, look for revised invoices/new cards coming in from your insurer that you weren't expecting. Had I checked the healthcare.gov site after I got that revised invoice in December or in May after I got those new cards from my insurer, I could have saved myself a lot of headaches (and money).
These were hard lessons learned, but they are ones I wanted to pass along to others who like me have few options but to use the marketplace. Stay on top of it every month to look for any unauthorized changes made to your application. It could save you a small fortune when tax time rolls around!
