What Should I do if Someone Signed me up for Health Insurance Marketplace Coverage Without my Consent?

Page last updated on Feb. 7, 2024

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Did your federal income tax return for last year indicate that you had health insurance coverage through the Marketplace (also referred to as Obamacare, Healthcare.gov and Affordable Care Act) and/or you owe IRS a repayment of premium tax credit, but you did not sign up for coverage?

If you were enrolled in a health plan in the Marketplace by another person (an insurance agent or broker) without your consent and knowledge, you should report this to the Marketplace and submit the claim for agent fraud.

On this page, you can find information on the following topics:

North Carolina residents, if you would like assistance with this process, our Health Insurance Navigators can provide you with free help.

Mecklenburg, Cabarrus and Union Co. residents, please call 980-256-3782

North Carolina residents in other counties, please call 1-855-733-3711

Visit ncnavigator.net

Next steps to follow if you were enrolled in a plan on the Health Insurance Marketplace without your consent

  1. Call the Health Insurance Marketplace (aka Obamacare) Call Center at 1-800-318-2596 to find the status of your enrollment. Even if you did not sign up of your own will, you may owe the IRS money back for premium tax credits you received.
  2. If the Marketplace reports you did not have coverage in 2022 and/or 2023, there is nothing else you need to do.
  3. If the Marketplace confirms you had coverage that you did not consent to AND you did not use this coverage for your doctor or hospital visits, follow these steps:
  • Ask the Marketplace representative to cancel/terminate any current active coverage you were fraudulently enrolled in, so that you do not continue receiving premium tax credits that you may not be eligible for.
  • Contact an Affordable Care Act Health Insurance Navigator to assist you with reporting your enrollment without a consent to the Center for Medicaid and Medicare, the federal government agency overseeing Marketplace, and to submit an agent fraud claim so that your coverage may be terminated retroactively (which would allow you to cancel your entire coverage from the original issue date). To receive assistance from a Health Insurance Navigator, call 980-256-3782 (Mecklenburg, Cabarrus and Union Co. residents) or 1-855-733-3711 (NC residents in other counties) for free assistance.
  • Next, the Marketplace Complex Case Help Center will investigate your claim. Only Navigators can submit this form, but both you and your Navigator will receive a call as part of this investigation in the days after submitting the agent/broker fraud. Upon investigation, you will be informed of the outcome and the next steps. 
  • Depending on the fraud claim outcome, you may receive an amended 1095A tax form that you may need to file with your federal income tax return. Make sure the Marketplace has the correct mailing address for you. Charlotte Center for Legal Advocacy Low-Income Taxpayer Clinic may be able to provide guidance with tax questions regarding your 1095A form. You can contact the clinic at 980-202-7329.
  • It is recommended that you file an agent fraud claim with the NC Department of Insurance as well. Visit ncdoi.gov or call 919-807-6840 (Toll-Free 888-680-7684). Your Navigator can assist you with this process. 
  • If you believe your identity has been stolen, you should report it to IdentityTheft.gov.
  • If you have questions about this process, want assistance or just want to understand your options for health coverage, Affordable Care Act Health Insurance Navigators can help. Call 980-256-3782 (Mecklenburg, Cabarrus and Union Co. residents) or 1-855-733-3711 (NC residents in other counties) for free assistance.

Who are Health Insurance Navigators and how can they help me with this process?

Health Insurance Navigators are licensed by the Center for Medicaid and Medicare, a federal agency that also administers Health Insurance Marketplace. Their services are FREE for everyone, and they do not get any financial incentives for their assistance. They help consumers understand what health options they are eligible for and assist with enrollment in Medicaid and Marketplace coverage. They cannot choose a health plan for you but can help answer questions about health coverage and guide a consumer through the enrollment process. Navigator services include reasonable accommodations for non-English speaking consumers or consumers with visual, hearing, or other impairments with no cost to consumers.

No, Health Insurance Navigators are not an insurance agent or broker. Navigators are federally licensed and provide free, unbiased help to consumers to help individuals understand their health options eligibility and assist with enrollment in Medicaid and Marketplace coverage. Navigators can also assist with processes concerning the Health Insurance Marketplace, such as enrollment in a plan without consent. Navigators receive no direct compensation for assisting an individual with the Health Insurance Marketplace or Medicaid.

Why is it important to report fraudulent enrollment in Marketplace coverage?

Every time someone applies for coverage through Marketplace, they are also applying for government financial assistance through advance premium tax credit to help lower your monthly health insurance payment (or “premium”). Advance Premium Tax Credit is approved based on the estimate of your expected income, the tax filing status, and other criteria for the year you will have coverage. This is reported on your Marketplace application.

If you qualify for a premium tax credit based on your estimate, tax filing status, and ineligibility for other health coverage, you can use it to lower the cost of your monthly premium for the plan you enrolled in.

You are legally required to file a federal income tax return for the year you had Marketplace coverage and reconcile the advance premium tax credit with your actual income for that year:

  • If at the end of the year you have received more premium tax credit than you are due based on your final income, you will have to pay back the excess when you file your federal tax return.
  • If you have received less than you qualify for, you will get the difference back.

If you were eligible for premium tax credits when you had coverage on Marketplace and you received the correct amount, all you need to do is submit this information with your tax return.

There are several reasons someone is not eligible for premium tax credits, for example you may not have an eligible immigration status, or you had an offer of or enrolled in an employer sponsored insurance (some exceptions apply). If you were eligible/ enrolled in Medicaid, Medicare, or other health coverage that meets the minimum essential coverage requirement, you WERE NOT eligible for premium tax credits.

What is not a fraudulent enrollment?

You cannot claim that you were fraudulently enrolled in a Marketplace health plan if:

  1. You agreed to be enrolled in Marketplace plan after you talked to a health insurance agent or broker.
  2. You willingly enrolled into the Marketplace plan with the help of an agent/broker, but later changed your mind and decided you do not want this coverage.
  3. You used your Marketplace health plan at any point to cover the cost of any medical services provided during the coverage year to you or any other tax household member listed on your Marketplace application.
  4. Your health plan premium cost was not fully subsidized (you were paying a portion of the premium).

What If I was enrolled in health coverage on Marketplace without my consent, but now I want to keep it?

If you have been enrolled without consent to a Marketplace health plan for 2024 and you decide that you may want to keep that plan, you should:

  1. Ask the Marketplace representative for the details of the plan (monthly premium, deductible amount, copays amount, out-of-maximum amount for 2024) so that you can understand the cost of this coverage and make an informed decision.
  2. Ask the representative to update your 2024 application to make sure you report any offer of insurance elsewhere (employer sponsored insurance, Medicare, Medicaid, TRICARE or VA Healthcare, etc..), your accurate tax filing status and your income for coverage year to make sure you will receive an accurate premium tax credit to lower you monthly premium. *Please note that if you are legally married you will need to include your spouse’s income on the Marketplace application and file jointly with your spouse for the year you had coverage, even if you do not live with your spouse. Some exceptions apply.
  3. If your employer offers health insurance, you are not eligible to be on Marketplace and receive premium tax credit unless the lowest premium cost of the plan your employer offers is more than 8.39% of your income.
  4. If you already enrolled in health insurance offered by your employer (or are eligible for any other minimum essential coverage, e.g., Medicaid, Medicare, or TRICARE), you are NOT eligible for Marketplace coverage and you should immediately cancel the Marketplace plan you were enrolled in for 2023. Otherwise, you may have to re-pay your premium tax credit when you file taxes.
  5. Make sure Marketplace has correct contact information to mail you your 1095A for 2024 coverage.
  6. Use your 1095A to reconcile any premium tax credits you received on your federal tax return.

Qué hacer si fui inscrito en la cobertura de salud en el Mercado (Obamacare) sin mi consentimiento

Ver información en Inglés

¿Su declaración federal de impuestos del año pasado indicó que tenía cobertura de salud a través del Mercado (Obamacare) y/o que debe un reembolso del crédito fiscal premium al IRS, pero usted no se inscribió en la cobertura?

Si alguien más (un agente o corredor de seguros) lo inscribió en un plan de salud del Mercado sin su consentimiento y conocimiento, debe informar esto al Mercado y presentar una reclamación por fraude de agente.

Por favor, siga estos pasos:

  1. Comuníquese al Centro de Llamadas del Mercado de Seguros Médicos (también conocido como Obamacare)  al 1-800-318-2596 para conocer el estado de su inscripción. Es posible que deba realizar un reembolso al IRS si se le otorgó un crédito tributario de prima para el que no era elegible.
  2. Si le informan que no tuvo cobertura en 2022 y/o 2023, no debe hacer nada más.
  3. Si el Mercado confirma que usted tenía cobertura sin consentimiento y no utilizó esta cobertura para visitas al médico y/u hospital, siga estos pasos:
  • Informe sobre su inscripción sin consentimiento y presente una reclamación por fraude de agente para que su cobertura sea cancelada retroactivamente. Pida al Mercado que cancele cualquier cobertura activa actual en la que lo inscribieron fraudulentamente, para que no siga recibiendo créditos fiscales premium para los cuales puede no ser elegible.
  • A continuación, el Mercado investigará su reclamación. Esto tomará al menos 30 días, pero puede tomar más tiempo. Tras la investigación, recibirá una carta con la resolución de la reclamación por fraude. Si no recibe noticias de ellos en un plazo de 30 días, puede llamar al Mercado para verificar el estado de la reclamación.
  • Según el resultado de la reclamación por fraude, es posible que reciba el formulario fiscal de impuestos 1095A enmendado que deberá ser presentado con su declaración de impuestos federales. La Clínica de Contribuyentes de Bajos Ingresos del Centro de Apoyo Legal de Charlotte puede responder preguntas relacionadas con el formulario 1095A. Si lo requiere puede contactarse al: 980-202-7329.
  • Se recomienda que presente una reclamación por fraude de agente ante el Departamento de Seguros de Carolina del Norte también. Visite ncdoi.gov o llame al 919-807-6840 (Llamada gratuita 888-680-7684).
  • Si cree que su identidad ha sido robada, debe informarlo en IdentityTheft.gov.
  • Si tiene preguntas sobre este proceso o sus opciones de cobertura de salud, los Navegadores de Seguros de Salud de la Ley de Cuidado de Salud a Bajo Precio pueden ayudarlo. Llame al 980-256-3782 para obtener asistencia gratuita.

Los Navegadores de Seguros de Salud pueden ayudarlo con este proceso. Puede llamar al 980-256-3782 para obtener asistencia gratuita.

Los Navegadores de Seguros de Salud están licenciados por el Centro de Medicaid y Medicare, una agencia federal que también administra el Mercado de Seguros de Salud. Sus servicios son gratuitos para todos, y no reciben incentivos financieros al ofrecer su ayuda. Ayudan a los consumidores a comprender las opciones de salud para las que son elegibles y los asisten en la inscripción en Medicaid y en la cobertura del Mercado. No pueden elegir un plan de salud por usted, pero pueden ayudarlo a responder preguntas sobre la cobertura de salud y guiar al consumidor a través del proceso de inscripción. Los servicios del Navegador incluyen adaptaciones razonables para consumidores que no hablan inglés o que tienen discapacidades visuales, auditivas u otras discapacidades sin costo para los consumidores.

¿Por qué es importante informar la inscripción fraudulenta en la cobertura del Mercado?

Cada vez que alguien solicita cobertura a través del Mercado, también está solicitando asistencia financiera gubernamental a través del crédito fiscal premium por adelantado para ayudar a reducir su pago mensual del seguro de salud (o “prima”). El Crédito Fiscal Premium por Adelantado se aprueba en función de la estimación de sus ingresos esperados, el estado civil para efectos de declaración de impuestos y otros criterios para el año en que tendrá la cobertura. Esto se informa en su solicitud al Mercado.

Si califica para un crédito fiscal premium en función de su estimación, estado civil para efectos de declaración de impuestos y la falta de elegibilidad para otra cobertura de salud, puede utilizarlo para reducir el costo de su prima mensual del plan en el que se inscribió.

Está legalmente obligado a presentar una declaración de impuestos federales del año en que tuvo cobertura del Mercado y conciliar el crédito fiscal premium por adelantado con sus ingresos reales de ese año:

  • Si al final del año ha recibido más crédito fiscal premium del que le corresponde según sus ingresos finales, deberá devolver el excedente cuando presente su declaración de impuestos federales.
  • Si ha recibido menos de lo que califica, recibirá la diferencia.

Si fue elegible para créditos fiscales premium cuando tenía cobertura en el Mercado y recibió la cantidad correcta, todo lo que necesita hacer es presentar esta información con su declaración de impuestos.

Hay varias razones por las que alguien no es elegible para créditos fiscales premium, por ejemplo, es posible que no tenga un estatus migratorio elegible o que haya recibido una oferta o se haya inscrito en un seguro patrocinado por el empleador (con algunas excepciones). Si fue elegible/inscrito en Medicaid, Medicare u otra cobertura de salud que cumple con el requisito de cobertura esencial mínima, NO será elegible para créditos fiscales premium.

¿Qué no es una inscripción fraudulenta?

No puede afirmar que fue inscrito fraudulentamente en un plan de salud del Mercado si:

  1. Aceptó ser inscrito en un plan del Mercado después de hablar con un agente o corredor de seguros de salud.
  2. Se inscribió voluntariamente en el plan del Mercado con la ayuda de un agente/corredor, pero luego cambió de opinión y decidió que no desea esta cobertura.
  3. Utilizó su plan de salud del Mercado en algún momento para cubrir el costo de cualquier servicio médico proporcionado durante el año de su cobertura o si cualquier otro miembro del hogar fiscal mencionado en su solicitud al Mercado hizo uso de este servicio.
  4. El costo de la prima de su plan de salud no estaba completamente subsidiado (usted estaba pagando una parte de la prima).

¿Qué sucede si fui inscrito en cobertura de salud en el Mercado sin mi consentimiento, pero ahora quiero mantenerla?

Si fue inscrito sin consentimiento en un plan de salud del Mercado para 2023 y decide que podría querer mantener ese plan, deberá:

  1. Solicitar al representante del Mercado los detalles del plan (prima mensual, monto del deducible, monto de copagos, monto máximo fuera de bolsillo para 2023) para que pueda comprender el costo de esta cobertura y tomar una decisión informada.
  2. Solicitar al representante que actualice su solicitud de 2023 para asegurarse de informar cualquier oferta de seguro en otro lugar (seguro patrocinado por el empleador, Medicare, Medicaid, TRICARE o VA Healthcare, etc.), su estado civil y sus ingresos exactos para el año de cobertura, para asegurarse de que reciba un crédito fiscal premium preciso para reducir su prima mensual. *Tenga en cuenta que si está legalmente casado, deberá incluir los ingresos de su cónyuge en la solicitud del Mercado y presentar una declaración conjunta con su cónyuge para el año en que tuvo cobertura, incluso si no vive con su cónyuge. Se aplican algunas excepciones.
  3. Si su empleador ofrece seguro de salud, no es elegible para estar en el Mercado y recibir créditos fiscales premium a menos que el costo de la prima más bajo del plan que ofrece su empleador sea superior al 9,12% de sus ingresos.
  4. Si ya se inscribió en un seguro de salud ofrecido por su empleador (o es elegible para cualquier otra cobertura esencial mínima, como Medicaid, Medicare o TRICARE), NO es elegible para la cobertura del Mercado y debe cancelar inmediatamente el plan del Mercado en el que se inscribió para 2023. De lo contrario, es posible que deba reembolsar el crédito fiscal premium cuando presente sus impuestos.
  5. Asegúrese de que el Mercado tenga la información de contacto correcta para enviarle su formulario 1095A para la cobertura de 2023.
  6. Use su formulario 1095A para conciliar cualquier crédito fiscal premium que haya recibido en su declaración de impuestos federales.

CLT Center for Legal Advocacy Offers Assistance to Migrants amid Ending of Title 42

Charlotte Center for Legal Advocacy announced its commitment to assisting migrants affected by the ending of Title 42, a provision that has been used to temporarily suspend immigration into the United States during times of public health emergencies. The Centers for Disease Control and Prevention (CDC) implemented Title 42 in March 2020 as a measure to control the spread of COVID-19.

“With the ending of Title 42 today, the Advocacy Center recognizes the need for urgent support to migrants who may have been impacted by this provision. We are committed to the protection and support of our community and to defending all immigrants—both the newly—arrived and those who have been here longer—in removal proceedings”, affirms Sharon Dove, Director of the Advocacy Center’s Immigrant Justice Program.

The Pro Bono Room consultation empowers the individual to make an informed choice about whether to spend money on legal fees, which can be extraordinarily expensive. Immigrants are also provided with guidance on how to represent themselves pro se. Advocacy Center hours in the Pro Bono Room are Tuesdays and Wednesdays from 9:00 a.m. – 12:00 p.m. The Charlotte Immigration Court is located at 5701 Executive Center Drive, Charlotte, NC in the fourth-floor suite.

The ending of Title 42 comes at a time when the United States is facing a surge of migrants at the southern border. To stem the flow, the Biden administration will immediately enact a “transit ban” that will deny asylum to vulnerable migrants who do not first attempt to seek asylum in countries through which they transit on their way to the United States.

“For us the transit ban policy makes no sense given the political and economic disarray and rampant gang violence in the countries that immigrants pass through on their way from Latin America to the US. Those countries have difficulty protecting their own nationals–let alone newcomers. The transit ban is a thinly-veiled attempt to drastically reduce the number of individuals eligible for asylum by limiting asylum to Mexicans and Canadians.”

Many of these migrants are fleeing violence, poverty, and persecution in their home countries, and are seeking a better life in the United States. Charlotte Center for Legal Advocacy recognizes the importance of providing support and assistance to these individuals and is committed to doing everything possible to ensure that their needs are met. “We believe that every person has the right to a safe and dignified life, regardless of where they come from,” said Sharon Dove.

We urgently need community support to ensure that our organization can continue to provide critical assistance to the many vulnerable migrants affected by the end of Title 42. Community donations will enable us to expand our services and support more individuals in need, including those who may have been impacted by the policy changes. To donate you can visit this link https://charlottelegaladvocacy.org/donate/ and help us ensure that no migrant is left without hope.

We are here to provide support to those who need it most, and we encourage everyone in need to reach out to us for free assistance: Client Helpline 704-376-1600, Outside Mecklenburg County: 800-438-1254. Línea de Ayuda en Español: 800-247-1931.

About Charlotte Center for Legal Advocacy

Charlotte Center for Legal Advocacy provides those in need with information, advice and advocacy in consumer protection, home preservation, health care access and public benefits, immigration, tax assistance and more. Our mission is to pursue justice for those in need. Our vision is to build a just community, where all people are treated fairly and have access to legal representation to meet their basic human needs of safety, economic security, and stability. Learn more: charlottelegaladvocacy.org