Avoiding Scams During Open Enrollment

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.

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.

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.

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.

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.

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.

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.

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.

You have rights to your Medicare privacy and decisions. Medicare agents must also follow specific rules.

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.

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.

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.

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.