Learn Tips to Prevent Medicare Open Enrollment Scams

Learn Tips to Prevent Medicare Open Enrollment Scams

Medicare’s annual open enrollment is from Oct 15 – Dec 7. It’s an important time of year to review the changes in your current coverage for the new year and look at your other coverage options. Sifting through your current plan’s coverage changes can be overwhelming to digest, let alone understanding all the other options available to you. This information overload and potential confusion creates a ripe situation for scams and fraud. While most plans/agents are here to help people, it’s important to be aware of the few “bad apples” out there. Below are some tips on knowing what to watch for, knowing what health plans and agents can and can’t do and how to protect yourself and loved ones to prevent enrollment fraud this fall.

To avoid enrollment fraud, watch out for people who:

  • Pressure you with time limits.
  • Ask for you Medicare number, Social Security number, and bank information.
  • Threaten you with loss of your Medicare benefits if you do not sign up.
  • Offer gifts to enroll.
  • Say they represent Medicare.
  • Call uninvited.

Protect yourself by:

  • Protecting your Medicare and Social Security number.
  • Being wary of any unsolicited calls from anyone asking for personal
  • Relying on government websites and emails for unbiased information.
  • Requesting translation services when needed.
  • Confirming everything that an agent tells you before making a final decision. Get it in writing if you can.
  • Being aware of your right to choose how you receive Medicare coverage.
  • Doing your homework before signing up with a plan.
  • Reviewing your current plan notice “Annual Notice of Change”.
  • Asking all your physician, hospitals, durable medical equipment suppliers if they take the plan.
  • Checking the plan’s Star Rating.
  • Thinking about what matters most.
    • Does it fit your budget?
    • Does it cover all of your drugs?

Make sure you know the rules for meeting with a Medicare plan and/or insurance agent. During the meeting, Medicare plans and plan agents CAN’T:

  • Charge you a fee to process your enrollment into a plan.
  • Steer you into a particular plan.
  • Communicate incorrect information about their plan type or use
    inappropriate statements like their plan is “the best” or “highest
  • Tell you about other plan options you haven’t agreed to discuss,
    unless you specifically ask about them (to discuss these options,
    you need to complete a separate appointment form).
  • Pressure you to join their plan by saying things like “you have to
    join this plan or you won’t have coverage next year.”
  • Ask you to give names and phone numbers or addresses so they
    can sell to your friends or family.
  • Ask you to sign the enrollment form before you’re ready to join.

If you feel a plan or agent has violated Medicare’s marketing rules, save all your documented proof. This includes: any signed papers, agent or plan representative’s business card, any questionable marketing material, and records of any phone calls. Then call our California Senior Medicare Patrol (SMP) to report any suspected enrollment fraud at 1-855-613-7080.

Karen Fletcher
Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.

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