Medicare scams are on the rise, particularly during open enrollment periods, which typically run from October 15 to December 7, with scammers trying to trick unsuspecting individuals into enrolling in what they believe to be “better” health plans.

During open enrollment, the Centers for Medicare & Medicaid Services (CMS) advise beneficiaries to review their current coverage to ensure it aligns with their needs for the upcoming year. While CMS advises annual reviews, seniors should be cautious about unsolicited offers, especially those claiming improved benefits without credible backing. The open enrollment period primarily focuses on making changes related to Medicare Part D and Medicare Advantage Plans, which encompasses Part A and Part B, and often include Part D.

The open enrollment period primarily focuses on making changes related to Medicare Part D and Medicare Advantage Plans, which encompasses Part A and Part B, and often include Part D.

Not sure what each plan covers? Here’s a breakdown.

• Medicare Part A coverage includes hospital stays and inpatient care
• Medicare Part B coverage includes certain doctors’ services, outpatient care, medical supplies, and preventative services.
• Medicare Part C, also known as Medicare Advantage, is typically offered through private insurance companies approved by Medicare and combines Part A, Part B, and sometimes Part D coverage. Medicare Advantage often provides extra coverage for vision, hearing, dental, and health and wellness programs. Most Advantage plans include Medicare prescription drug coverage (Part D) as well.

While Medicare Advantage (Part C) plans offer valuable benefits and coverage options for Medicare beneficiaries, make sure you can distinguish between legitimate insurers and fraudulent schemes. As noted above, Medicare Advantage plans can provide additional benefits beyond Original Medicare (Parts A and B). However, scammers often exploit the popularity of these plans to deceive people into enrolling in fake or subpar programs.

The Scam

Here are a couple of different ways scammers operate and how to avoid a Medicare plan scam:

• Preapproval Claims. Be wary if you receive a call informing you that you’re preapproved for a plan with better coverage than your current one. Always ask questions and conduct your research, as many of these companies might be fraudulent or misrepresenting their benefits to entice your into paying more.
• Impersonating Medicare Representatives. Exercise caution if someone contacts you claiming to be a Medicare representative during open enrollment. Remember, Medicare typically communicates through the mail first and rarely initiates direct phone calls. Avoid following up on unsolicited calls, brochures, or visits from alleged Medicare representatives unless you have an established relationship with them.

Spot It

Let’s look at a hypothetical example to show how this scam might unfold. We’ll use “XYZ Insurance”. This fictitious company operates a telemarketing scam targeting seniors during the open enrollment period. Using aggressive sales tactics, XYZ representatives contact unsuspecting individuals, claiming to offer exclusive Medicare Advantage plans with unbeatable benefits and low premiums.

Here’s how the scam works:

• Misleading Claims. Representatives falsely claim that their Medicare Advantage plans provide superior coverage compared to traditional Medicare or other insurance options. They may exaggerate benefits such as coverage for extended hospital stays, additional prescription drug coverage, or zero copayments for medical services.
• High-Pressure Sales Tactics. XYZ employs high-pressure sales tactics to persuade potential victims, creating a sense of urgency and fear of missing out on purportedly limited-time offers. They may use phrases like “act now” or “don’t miss this opportunity”, urging people to enroll immediately without fully understanding the terms and conditions. It’s important to stay vigilant and check the validity of the offer.
• False Affiliation. XYZ Insurance may claim affiliation with Medicare or use names similar to well-known insurance providers to gain trust and legitimacy. However, upon closer inspection, these claims prove to be deceptive, as XYZ is not an authorized Medicare Advantage provider.
• Phishing for Personal Information. Once prospects express interest in the supposed Medicare Advantage plans, XYZ representatives request sensitive personal information, such as Medicare numbers, Social Security numbers, and banking details. Victims, believing they’re signing up for legitimate coverage, unwittingly provide this information, exposing themselves to identity theft and financial fraud.

In this example, seniors who fall victim to XYZ Insurance’s scam may find themselves enrolled in nonexistent or substandard Medicare Advantage plans, facing exorbitant costs, limited coverage, and difficulties accessing healthcare services. Even worse, their personal information may be compromised, leading to further exploitation by identity thieves.

What You Can Do

Here are some steps you can take to safeguard yourself from falling victim to Medicare scams:

• Understand how Medicare works and familiarize yourself with the official enrollment process. Knowledge is your best defense against fraud. Medicare plans can be complicated. You can check the Medicare website, contact Medicare directly with questions, or discuss plans with your insurance company or a trusted source. Don’t rely on unsolicited calls from telemarketers for information.
• If you receive a call from someone claiming to represent Medicare or a private insurance company, ask for their name, company, and contact information. Research the legitimacy of the caller before sharing any personal or financial details.
• Never provide sensitive information such as your Medicare number, Social Security number, or bank account details to unsolicited callers or strangers.
• Use caller ID to screen incoming calls and avoid answering unfamiliar numbers or those that appear suspicious – but don’t rely on it. Scammers may spoof Caller ID information, meaning that a trusted name appearing on your caller ID does not always guarantee legitimacy.
• If someone claims to be from a legitimate organization, ask for their name, department, and contact information. Hang up and independently verify their identity by calling the organization’s official phone number that you found on their website or from a trusted source.
• Contact the Federal Trade Commission, National Consumers League Fraud Center, or Federal Communications Commission about suspicious calls. You can also schedule an appointment with local senior centers or State Health Insurance Assistance Program (SHIP) counselors for personalized help.
• Keep abreast of common scams targeting seniors and educate yourself on recognizing and avoiding them. Visit medicare.gov, or call 1.800.MEDICARE (1.800.633.4227) for the most current information.

Reporting Fraud

If you think you’re a Medicare scam victim, report it immediately.

• Call 1.800.MEDICARE (1.800.633.4227). TTY users can call 1.877.486.2048
• Call the fraud hotline of the Department of Health and Human Services Offline of the Inspector General at 1.800.HHS.TIPS (1.800.447.8477). TTY users can call 1.800.377.4950. Report the scam even if it didn’t result in a loss.

Visit tips.oig.hhs.gov to file a complaint online. Be sure to include the details of the scam attempt, such as the phone number or any other identifying information about the scammer, to assist in the investigation. Keep documentation of all communications with potential scammers, such as dates, times, methods of communication, and content discussed as well. Remember that Medicare scams usually increase during open enrollment. You can reduce the risk of falling victim to these deceptive tactics by staying informed, remaining vigilant, and safeguarding personal information. If you receive a suspicious call, it’s OK to hang up and verify the caller’s identity through official channels.

Still have questions about fraud and want to protect yourself from scams, check out our Security page and contact us to learn more.