GAO report on health insurance plan efficacy

Aug. 12, 2021

Since 2014, millions of consumers have purchased individual market health insurance plans through the health insurance exchanges—or marketplaces—established under the Patient Protection and Affordable Care Act (PPACA). Sales representatives listed on Department of Health and Human Services' (HHS) website can also sell other types of health coverage arrangements that may cost less but may not cover all pre-existing conditions as comprehensive PPACA-compliant plans do. 

The Government Accountability Office (GAO) performed 31 covert tests on selected sales representatives listed on These tests involved stating that the (fictitious) applicant had pre-existing conditions—either diabetes or heart disease—and requesting coverage for these conditions to see if the sales representative directed the applicant to a comprehensive PPACA-compliant plan or a PPACA-exempt plan that does not cover what the fictitious applicant requested.

As part of these tests, GAO gauged whether the selected sales representatives engaged in potentially deceptive practices, such as making false or misleading statements about coverage or omitting material information about coverage.

All 31 sales representatives GAO contacted appropriately referred GAO's fictitious applicant to a PPACA-compliant plan. The majority of sales representatives also explained that a PPACA-exempt plan would not cover the applicant's pre-existing condition. None of the sales representatives GAO contacted engaged in potentially deceptive marketing practices that misrepresented or omitted information about the products they were selling.

Since 2014, millions of Americans have purchased health insurance through exchanges—or marketplaces—established under the Affordable Care Act. GAO investigators posed as people with pre-existing conditions seeking health insurance to test if sales representatives listed on from 5 states used deceptive practices. Of the 31 sales representatives we contacted:

  • None engaged in deceptive marketing practices that misrepresented or omitted information
  • All referred us to an appropriate plan that covered pre-existing conditions
  • Most explained that the less-expensive plans allowed since 2018 might not cover pre-existing conditions

GAO report