Avoiding Scams During Open Enrollment
Medicare scams are more likely to occur during or near open enrollment, which is Oct. 15 through Dec. 7. Don’t share personal information, like your Medicare number or banking information to strangers. Scammers aren’t just in person anymore — they can reach you through email or phone calls. Learn how to be wary of scams during open enrollment to protect yourself.
- Written by Lindsey Crossmier
Lindsey Crossmier is an accomplished writer with experience working for The Florida Review and Bookstar PR. As a financial writer, she covers Medicare, life insurance and dental insurance topics for RetireGuide. Research-based data drives her work.Read More
- Edited ByLamia Chowdhury
Lamia Chowdhury is a financial content editor for RetireGuide and has over three years of marketing experience in the finance industry. She has written copy for both digital and print pieces ranging from blogs, radio scripts and search ads to billboards, brochures, mailers and more.Read More
- Reviewed ByEric Estevez
Owner of HLC Insurance Broker, LLC
Eric Estevez is a duly licensed independent insurance broker and a former financial institution auditor with more than a decade of professional experience. He has specialized in federal, state and local compliance for both large and small businesses.Read More
- Published: August 17, 2022
- Updated: May 8, 2023
- 7 min read time
- This page features 7 Cited Research Articles
- Edited By
What Kind of Medicare Scams Exist?
Medicare scams can happen over the phone, through email, in person or even in postal mail. Most attempt to steal your Medicare number or personal information. If they are successful, the scammer could steal your identity, falsify your records or charge you for services that were never delivered.
- Offer free medical care or durable medical equipment
- Perform fake DNA swabs for cancer testing
- Offer refund due to change of Medicare coverage
- Announce Medicare is changing to new cards
The main goal of the Medicare scams listed above is to get your personal information. In any scenario above, they will likely request your Medicare number, Social Security number or other relevant private information. If the scammer succeeds and you confide your personal information to them — the scammer could commit further fraud in your name.
Medicare eligibility and enrollment can be a difficult and confusing process. That’s why so many scammers prey on older adults during this time. Unfortunately, many scammers succeed, costing taxpayers billions of dollars each year, according to the U.S. Centers for Medicare & Medicaid Services.
In July 2022, the Department of Justice announced criminal charges that were worth over 1.2 billion in medical fraud schemes alone. But there are legal protections in place to deter fraud.
Awareness for each Medicare scam scenario can help you protect your assets and prevent criminals from targeting you.
Aggression and Threats
Scammers may resort to threatening or intimidating you to get information. Some may claim they will cancel your Medicare coverage if you don’t provide information, but this isn’t true.
According to U.S. Centers for Medicare & Medicaid Services, your plan could only be canceled if you put false or incomplete information on your application, or if you didn’t pay your premiums. You must also be given at least 30 days’ notice before canceling. If someone is threatening to cancel your coverage immediately, then it is a scam.
Medicare representatives will never go door to door to sell you Medicare products or services. These scammers are likely to offer additional benefits, like vision, dental or life insurance coverage. Then, they will request your personal information to use it for their own gain.
Unsolicited Calls, Emails and Mail
Scammers will try to get your information through calls, emails and postal mail. The scammer may say they simply need to verify or update your information. Do not provide information or chat as it will encourage the scammer to keep contacting you.
Scammers are using technology to try to seem legitimate. Some link the actual website within their email or change their caller ID to appear they are from Medicare.
What Are the Warning Signs of a Medicare Scam?
Being pressured or coerced to provide personal information is a big red flag. Promises of free items or services are other factors to consider. Other warning signs include any unsolicited calls, emails or in-person visits related to Medicare. A Medicare representative will only reach out to you if you request aid.
Where you live can also influence how susceptible you are to suffer from a Medicare scam. The Coalition Against Insurance Fraud analyzed the Better Business Bureau’s Medicare scam reports from 2015 to 2020. They found that the state with the most Medicare scams is Ohio. Nine cities were also noted to have high Medicare scam rates.
- New York
- San Antonio
- Los Angeles
- Saint Louis
The best way to recognize warning signs of a scam is by being vigilant to those requesting your personal information. Be extra wary if you live in an area where Medicare scams are more common.
What Can You Do to Avoid Medicare Scams?
Keeping an eye out for the warning signs referenced above, like unsolicited calls, promises of free services or requesting confidential information, can help you avoid Medicare scams.
There are additional precautions you can take to avoid Medicare scams. This includes reviewing your Medicare claims, knowing your rights, avoiding door-to-door salespeople and learning about your Medicare coverage.
Review Your Medicare Claims
Record the health care services you receive and make sure the dates match on your Medicare claim. Put details in your records so you know what treatments, medications or durable medical equipment you are responsible for. This can help you avoid getting double charged or charged for a service or item you didn’t receive at all.
If you have Original Medicare, you should receive a Medicare Summary Notice every three months, or once a month if you opt to receive them electronically. Utilize these often to make sure your records are in order.
If you don’t review your Medicare claims often, it will be easier for scammers to take advantage of you.
Know Your Rights
You have rights to your Medicare privacy and decisions. Medicare agents must also follow specific rules.
- An agent cannot insinuate that Medicare prefers a specific plan.
- Your agent will only provide information regarding the items you listed in your appointment form. They cannot offer sales advice on Medicare products you didn’t list or ask about on your appointment form.
- Agents can’t shift time limits for plan signup. The deadline is Dec. 7, and there are no additional benefits for enrolling early.
- An agent cannot threaten to take away your benefits.
If an individual who claims to be an agent takes any of the actions listed above, they are not a legitimate agent and are trying to scam you.
Avoid Door-to-Door Salespeople
If a stranger knocks on your door, make sure to ask them what they are trying to sell. If it is a Medicare-related service or product — it is a scam. Do not open the door or chat casually with them as they could trick you to share your personal information.
Learn about Medicare Coverage
Each part of Medicare covers a different service or medication. It is a red flag if a provider tells you there’s a way to cover a service that isn’t typically covered.
For example, dental isn’t covered under Original Medicare. If an agent offers free dental with your Original Medicare plan — it is a scam.
However, some Medicare Advantage plans do include basic dental coverage. You can avoid Medicare scams by learning about Medicare coverage.
How to Report Medicare Scams and Fraud
To report Medicare scams and fraud, you can either call 1-800-MEDICARE (1-800-633-4227) or submit a claim online to the Office of Inspector General.
You should gather information before submitting your claim. The more proof you provide, the easier it will be to investigate and pursue your claim.
- Relevant photos, documents or billing records
- Names and contact information (address, phone number, email address) of the person or business related to your scam or fraud complaint
- Time frame information, explaining when and how you became aware of the fraud or scam
- Name and contact information of any individual able to confirm the scam or fraudulent activity
7 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2022, July 20). Nationwide Coordinated Law Enforcement Action to Combat Telemedicine, Genetic Testing, and Durable Medical Equipment Fraud and CMS Administrative Actions. Retrieved from https://www.cms.gov/About-CMS/Components/CPI/CPI-Spotlight
- U.S. Centers for Medicare & Medicaid Services. (2022, March). Protecting Yourself & Medicare from Fraud. Retrieved from https://www.medicare.gov/Pubs/pdf/10111-Protecting-Yourself-and-Medicare.pdf
- Federal Trade Commission Consumer Advice. (2021, October 15). Avoid Marketing Scams During 2022 Medicare Open Enrollment. Retrieved from https://consumer.ftc.gov/consumer-alerts/2021/10/avoid-marketing-scams-during-2022-medicare-open-enrollment
- NC Department of Insurance. (2020, October 26). Attention! Door-to-Door Medicare Insurance Scams on the Rise. Retrieved from https://www.ncdoi.gov/news/press-releases/2020/10/26/attention-door-door-medicare-insurance-scams-rise
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Health Insurance Rights & Protections. Retrieved from https://www.healthcare.gov/health-care-law-protections/cancellations/
- Coalition Against Insurance Fraud. (n.d.). Fraud Stats. Retrieved from https://insurancefraud.org/fraud-stats/
- Office of Inspector General. (n.d.). Before You Submit a Complaint. Retrieved from https://oig.hhs.gov/fraud/report-fraud/before-you-submit/
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