Open Enrollment is Upon Us: BEWARE OF JUNK HEALTHPLANS

by Kollet Koulianos, Senior Payer Consultant Hemophilia Alliance

As healthcare open enrollment nears, it’s essential for our HTCs to inform patients who are buying their own insurance (outside of employer-sponsored plans) about the dangers of “junk health plans.” These plans often provide limited coverage and can leave patients with significant out-of-pocket costs. Junk plans are expected to be more common this year, except in the 12 states and Washington, D.C., that have passed laws banning their sale. However, even in those states, certain junk plains (such as Christian ministry plans and Farm Bureau plans) are still allowed to be sold. These plans aren’t classified as insurance but often function as what we consider “junk plans,” especially for those with chronic health conditions.

These plans are often appealing because of their affordability but come with major red flags: limited provider networks, no prescription drug coverage, and exclusions for pre-existing conditions or high-cost specialty medications. For people living with diseases like hemophilia, multiple sclerosis, diabetes, or cancer, those gaps aren’t just inconveniences—they’re life-threatening.

Chronic disease care requires consistency, coordination, and access—not fine print. Before enrolling, patients should verify that a plan covers their prescribed medications, make sure their specialists are in-network, and the plan complies with Affordable Care Act protections.

How Our Patients Can Identify Junk Health Plans

1. Look for the Fine Print

If a plan doesn’t comply with Affordable Care Act (ACA) requirements—such as covering essential benefits—it’s not true comprehensive insurance. Signs might include:

• Excluding preexisting conditions or limiting annual payouts.
• Not covering specialty medications
• Being described as “temporary,” a “bridge plan,” “health sharing,” or “fixed indemnity”
• Capping coverage, requiring large upfront payments, or refusing to cover your medications of specialists
• Make sure your specialist and/or treatment center is actually in network. Some junk plans claim you can “see any doctor,” but offer little to no reimbursement for those visits

2. Red Flags to Watch For

Be cautious if a plan shows any of these warning signs:

• Not available on Healthcare.gov
• Marketed through social media ads or robocalls
• Sold by “benefit associations” or “faith-based” groups rather than licensed insurers

For chronic conditions, prescription coverage is crucial, watch for:

• “Discount cards” instead of real prescription coverage
• Exclusion of specialty medication
• Use of “alternative funding” schemes that require you to apply for copay assistance instead of using your insurance benefits
  Remember: Only ACA-compliant plans sold through legitimate state or federal marketplaces guarantee essential health benefits and consumer protection.

3. Trust Your Instincts

If the deal seems too good to be true (such as $200/month for “comprehensive” coverage) it almost always is.

Bottom Line

Real health plans protect you when you need care the most. Junk plans protect insurers’ profits instead. Before enrolling, check with:

• Healthcare.gov
• Your state insurance department
• Reach out to your MCR team member at the Hemophilia Alliance.

Because when it comes to chronic disease, a “cheap” plan can become the most expensive decision of your life.