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9 Medicare Open Enrollment Scams To Avoid

How to avoid 9 common Medicare Open Enrollment scams and where to find trustworthy information and get help

Avoid common Medicare Open Enrollment Scams

The annual Medicare Open Enrollment period from October 15th to December 7th gives scammers the perfect opportunity to prey on unsuspecting older adults and family caregivers. 

The confusion around choosing the right plan gives scammers the chance to convince people to share their sensitive personal and financial information.

Here, we share 9 common Medicare Open Enrollment scams to be aware of, 3 ways to get trustworthy Medicare information, and how to report Medicare scams and get help.

Knowing how these scams work helps you and your older adult avoid falling victim to identity theft and Medicare fraud.

Use these quick links to jump to each scam:


9 top Medicare Open Enrollment scams

1. Fake Medicare representatives who call or knock on the door Key takeaway: There are no government or ”official” Medicare sales representatives or agents. The Center for Medicare and Medicaid Services (CMS) will never call to ask for or check Medicare numbers. They will not call or knock on your door to offer savings or discounts.

Details: In this scam, fraudsters will call on the phone or knock on your door pretending to be Medicare representatives or agents. 

They’ll typically offer thousands of dollars worth of “limited time” savings on future health care costs – if you sign up now. 

Or, they’ll offer to share important enrollment information if you just provide your Medicare number.

Watch out, these are outright scams. These thieves are trying to steal your Medicare or Social Security number or bank or credit card information.

Then the scammers use your personal information to steal your identity, sign you up for Medicare plans you didn’t agree to, or file false Medicare claims.

Be aware that Caller ID information can no longer be trusted to distinguish real, legitimate calls from scam calls.

Scammers have technology that allows them to fake the organization name and phone number that they’re calling from so that it appears legitimate or familiar on Caller ID. These thieves could be calling from anywhere.

2. Asking for your Medicare or Social Security number or other personal information To add to #1 above, the important thing to remember is that Medicare will never call to ask for a beneficiary’s Medicare number or Social Security number.

Plus, they’ll also never ask for your credit card number or bank account information.

If someone calls and claims to be a Medicare representative or agent and asks for sensitive information like this, hang up immediately.

Then, call 1-800-MEDICARE to report the fraud.

3. Threatening the loss of Medicare benefits or coverage Key takeaway: Medicare Part D prescription coverage is optional. Medigap plans are also optional. Your Medicare benefits won’t be terminated or canceled because you choose not to have those optional plans.

Details: In this scam, a fraudster calls to say that the older adult must have a prescription drug coverage plan (also called Medicare Part D) or they will lose their other Medicare benefits.

If the older adult doesn’t purchase a plan during the open enrollment period, then their Medicare benefits will be “terminated.”

Then, the fraudster will conveniently offer a great Part D plan that increases their prescription drug coverage, saves money, and allows them to keep their Medicare benefits.

This is a complete scam.

The Medicare prescription drug benefit is an optional addition to the coverage under Original Medicare (Parts A and B). Medigap policies are also completely optional and might be used as part of this scam.

Neither of these plans are required in order to maintain Medicare healthcare benefits.


4. Fake refunds or rebates Key takeaway: Medicare will never call to ask for a beneficiary’s Medicare number or Social Security number. They’ll also never ask for your credit card number or bank account information.

Details: In this scam, the fraudster calls to notify the Medicare beneficiary that they’re owed a refund or rebate, typically from the “donut hole” prescription drug coverage gap.

But in order for them to deposit the refund into their bank account, they’ll need personal information like birth date, Medicare number, Social Security number, and bank account.

This is a scam to try to gain access to sensitive personal information.

Medicare will never call to ask for a beneficiary’s Medicare number or Social Security number. They’ll also never ask for your credit card number or bank account information.

5. The free durable medical equipment or medical test scam Key takeaway: Medicare won’t contact you to offer special free or no-cost testing or durable medical equipment if you provide your Medicare or Social Security number.

Details: Another common scam is to offer to send “free” durable medical equipment like canes, knee braces, etc. at no cost. Or, the Medicare beneficiary could get no-cost tests to rule out serious health conditions.

All that’s needed is their Medicare or Social Security number.

This is another scam to steal sensitive personal information that will be used to defraud Medicare by billing for high-cost equipment or for identity theft.

While the older adult may receive cheap equipment to make them believe that this is real (so they don’t report the fraud), this is definitely still a scam.

6. Fake websites, emails, postal mailers, brochures, and other sales materials Key takeaway: Be very cautious if you get sales materials that claim to come from a government agency. Check with CMS to find official information and notices about your Medicare plan.

Details: Scammers can create and distribute very official-looking brochures and sales materials for Medicare products and services that they claim are available at discounted prices during the open enrollment period.

Of course, these are fake offers intended to get sensitive personal information.

Private insurance companies like Cigna, Kaiser Permanente, Aetna, Humana, UnitedHealthcare and Blue Cross Blue Shield do sell Medicare Advantage Plans, Medicare Supplement Plans, and Medicare Prescription Drug Plans. 

CMS approves and standardizes these plans, but they DON’T directly promote or sell any of these plans.

If you or your older adult receives mail, brochures, or emails about Medicare products or services that you’re interested in, don’t use the contact information shown in those sales materials.

Scammers can set up fake call centers and create fake websites that look identical to real ones in an attempt to steal sensitive personal information. 

Instead, call Medicare directly at 1-800-MEDICARE (1-800-633-4227) to find out more. Or look up and compare available plans in your area using Medicare’s Plan Compare Tool.


7. Aggressive, deceptive, or predatory sales tactics Key takeaway: Be aware of what legitimate insurance agents can and can’t do by law, so you can spot dishonest practices right away. This helps you detect scammers and also helps you avoid getting pressured into buying real insurance coverage that isn’t right for your situation or isn’t even needed.

Details: High-pressure sales tactics are common among scammers. They try to cause fear and panic and don’t want you to have time to think clearly about what’s happening so you’ll give them your sensitive personal information.

Just remember that insurance agents can’t set their own time limits for you to sign up for a plan. Everyone has until December 7 to enroll and there aren’t any extra benefits for signing up early.

They also can’t threaten to take away your benefits if you don’t sign up for a plan or offer you gifts if you agree to sign up.

While it’s possible that some legitimate insurance agents could sink to using aggressive or deceptive sales practices like these, it’s not as common.

However, legitimate agents might lure seniors into buying insurance products that don’t meet their needs even if they’re real Medicare Advantage Plans, Medigap policies, Part D plans or other insurance products.

To avoid getting caught up in these tactics whether it’s from a scammer or a legitimate insurance agent, it’s important to know that there are federal regulations that provide strict oversight of Medicare product sales and marketing. 

These marketing regulations are available on the CMS website here and specify how agents/brokers may and may not advertise, market, and communicate about Medicare products.

The National Council on Aging (NCOA) also has a clear and straightforward explanation of what’s allowed and what’s not in plain language here.

For example, door-to-door solicitation is prohibited. Unsolicited telephone calls, emails, and social media messaging are also not allowed.

It’s also not allowed to post plan-specific information in the waiting rooms or treatment areas of healthcare settings. 

Yet another example is that during a scheduled appointment, a plan representative can only discuss products and plans that the Medicare beneficiary gave permission to discuss before the appointment started.

In addition, a representative isn’t allowed to sell a non-health related product, like an annuity or life insurance policy, during a sales pitch for a Medicare health or drug plan.

If you or your older adult have been approached by a salesperson who acted inappropriately or aggressively or been enrolled in an insurance plan without consent, call 1-800-MEDICARE and file a complaint.

You can also find your state department of insurance in the Insurance Information Institute directory and file a complaint.

8. The bait and switch Medicare plan scam Key takeaway: When working with scammers or unscrupulous agents, people thought they were buying comprehensive health insurance coverage, but they were actually sold worthless limited indemnity or discount plans that didn’t provide anywhere near the coverage they expected.

Details: In this scam, people are lured in by the seemingly amazing healthcare plans that are advertised, but instead are sold plans that offer essentially no coverage.

A popular plan used in this scam is a short-term health insurance plan that’s a low-cost option during brief gaps in coverage.

Because these plans are short term, they’re exempt from the minimum coverage standards of the Affordable Care Act. Scammers and crooked brokers downplay or don’t mention this during their aggressive sales pitch.

Other types of plans used in this scam have been shown to discriminate against people with preexisting medical conditions and basically don’t provide coverage against catastrophic medical costs.

To protect against this scam, after choosing a plan, be sure to get all the details in writing before signing up. Take the time to read all the information and verify the details.

For example, before actually signing up for a specific plan, call your or your older adult’s doctors to ensure they’re in that plan’s network.

9. The Medicare giveback scam Key takeaway: Ads for certain Medicare plans show excellent benefits (like medical, dental, transportation) and promise that beneficiaries will get money back each month.

While a small number of plans across the nation may provide some of these benefits, they’re NOT widespread. It’s not common that someone would get these promised benefits.

Details: These “Medicare giveback plans” sound too good to be true – because they are.

First, to qualify for a Medicare premium reduction plan, you must:

  1. Be a Medicare beneficiary enrolled in Part A and Part B

  2. Be responsible for paying the Part B premium

  3. Live in a service area of a plan that has chosen to participate in this program

The most important thing to know here is that you must be in a specific service area for a participating program – and these are few and far between.

Plus, most of these premium reduction plans don’t offer more than one or two of the advertised benefits.

For example, a plan may offer premium reduction, but not dental, transportation, or meals. Other plans might have premium reduction and dental, but no transportation or meals. Or, maybe it only has premium reduction, but nothing else.

Plus, additional benefits the plan chooses to provide can come with limits, like only up to 12 meals per discharge for three qualified hospital stays in a year.

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By DailyCaring Editorial Team


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