5 Medicare Open Enrollment Scams to Avoid


Con artists and scammers are constantly inventing new ways to take advantage of people. Unfortunately, older adults tend to be more trusting of strangers and less aware of the newest ploys these dishonest people use, making them a common target. The annual Medicare Open Enrollment period offers the perfect opportunity for duping unsuspecting elders into sharing their sensitive personal and financial information.

Below are some common tactics that scammers use on Medicare beneficiaries around the open enrollment period each year. This information will help you avoid falling victim to identity theft and/or Medicare fraud and allow you to warn others about these schemes.

1. Bogus Medicare Representatives

This tactic involves an “official Medicare agent” either cold calling a senior or knocking on their door. The phony agent says they’re selling Medicare insurance that can save the senior thousands of dollars in health care costs next year, but the offer is only good during the open enrollment period. Sounds tempting, right?

The fact is that the Centers for Medicare and Medicaid Services (CMS) does not employ any Medicare sales representatives and typically issues all communications in writing. CMS is only authorized to call beneficiaries in two specific situations:

  • A Medicare health or drug plan can call you if you’re already a member of the plan. (The agent who helped you join can also call you.)
  • A customer service representative from 1-800-MEDICARE can call you if you’ve called and left a message or a representative said that someone would call you back.

Ignore cold calls and be wary of anyone who shows up unannounced at your home offering products or services of any kind. If you haven’t asked for an agent to contact you, federal law prohibits legitimate insurance agents from trying to sell to you, whether it’s via a phone call, an e-mail or a knock on your front door. If an “agent” or “representative” tries to sell you something on behalf of Medicare unsolicited, you should report that person to the authorities immediately.

Keep in mind that there are legitimate insurance agents and brokerage firms that sell Medicare Supplement Insurance (Medigap), Medicare Part D plans and Advantage Plans on behalf of private insurance companies. Some of these entities work with marketing and lead generation companies that advertise heavily online and on television. Legitimate firms and licensed brokers are not scammers. They sell real Medicare policies, but be aware that they may only offer a limited number of plans from certain carriers, they may charge fees and they receive commissions for the sales they make.

2. Threatening a Loss of Coverage

This scam usually begins with a senior receiving a call that says they must have a prescription drug coverage plan (also known as Medicare Part D) or they will lose their other Medicare benefits. If the senior doesn’t purchase a plan during enrollment time, then their Medicare benefits will be “terminated.” Of course, this caller claims to offer just the right Rx plan for the senior to increase their coverage and safeguard their benefits.

Sound a little too good to be true? That’s because it is. If someone says you must join a plan or buy some sort of coverage to avoid losing your other Medicare benefits, it’s a scam. The Medicare prescription drug benefit is an entirely optional addition to your coverage under Original Medicare (Parts A and B). The same goes for Medigap policies.

3. Fake Rebate Notices

In this scenario, a scammer calls a Medicare beneficiary to notify them that they are owed a substantial refund because they’ve reached the prescription drug coverage gap known as the “donut hole.” Of course, the catch is that the senior must provide their birth date, Social Security number, bank account and Medicare number so the refund can be automatically deposited into their checking account.

The important takeaway here is that Medicare will NEVER call and ask for a beneficiary’s Medicare number or Social Security number. Guard your personal information. Treat Medicare, Medicaid and Social Security numbers like a credit card number, and never give these out to a stranger. If someone claims to be with Medicare and asks for sensitive information like this over the phone, hang up and report it to 1-800-MEDICARE.

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4. Counterfeit Sales Materials

Scammers sometimes create and circulate very official-looking brochures and sales materials for new Medicare products that are available at a “discounted price” during the open enrollment period. They then count on seniors to contact them about enrolling and collect their personal information, payment information or both.

Don’t be fooled by sales materials that look like they’re from a government agency. Private insurance companies like Cigna, Kaiser Permanente, Aetna, Humana, UnitedHealthcare and Blue Cross Blue Shield sell Medicare Advantage Plans, Medicare Supplement Plans and Medicare Prescription Drug Plans. CMS approves and standardizes these plans, but they do not directly promote or sell any of these options.

Be skeptical of promotional materials claiming to come from the government. If you’re not sure if the materials you’ve received are legitimate, you can access a full list of the kinds of notifications and information that CMS and your existing plan(s) may send out via mail on Medicare.gov.

If you receive any mail or digital communication about Medicare products that you are interested in acting on, do not use the contact information listed on these materials. Instead, call Medicare directly at 1-800-MEDICARE (1-800-633-4227) or look up and compare available plans in your area using Medicare’s Plan Compare Tool.

5. Predatory Medicare Insurance Sales Tactics

Unfortunately, even legitimate insurance agents may be tempted into using aggressive or deceptive sales practices to lure seniors into buying real Medicare Advantage Plans, Medigap policies, Part D plans or other insurance products. Fred Riccardi, president of the Medicare Rights Center, a non-profit organization that helps people understand the Medicare system, says seniors and their families should be aware of what agents can and can’t do, so they’re able to spot dishonest practices right away. Not only will this help you detect scammers posing as insurance salespeople, but it will also ensure you do not get pressured into buying real insurance coverage that you do not want or need.

Federal regulations provide for strict oversight of Medicare product sales and specify how agents/brokers may and may not advertise, market and communicate about these products. For example, it is illegal to market Medicare products at educational events and in places where health care is delivered (e.g., exam rooms, pharmacy counters, hospital patient rooms, dialysis centers). Additionally, it is illegal to market additional non-health related products during personal marketing appointments with Medicare beneficiaries. For example, if a senior requests information on Medicare Advantage Plans, an insurance agent can’t recommend they buy an annuity.

Visit Medicare.gov for a complete list of rules that people representing Medicare plans must follow. Seniors do have rights. If you have been approached by a salesperson who acts inappropriately or aggressively, or if you’ve been enrolled in an insurance plan against your will, call 1-800-MEDICARE and file a complaint. Also, contact your state department of insurance using the Insurance Information Institute directory and file a grievance.

Avoiding Fraud and Scams During Medicare Open Enrollment

Going through CMS directly is the safest way to explore your options and make changes to your coverage. If you need help comparing plans and finding the best one for your situation, contact your local Area Agency on Aging (AAA) and make an appointment with the State Health Insurance Assistance Program (SHIP) to get free health insurance benefits counseling.

Sources: Identity theft: protect yourself (https://www.medicare.gov/forms-help-resources/identity-theft-protect-yourself)

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