Spot health insurance scams

Spot health insurance scams

Analyzing your health insurance options can be complex, overwhelming, and confusing. Some dishonest companies and scammers know this and use it to their advantage. Instead of getting the health insurance coverage you and your family need, you could end up with one of the so-called “health plans” that cover few or none of your medical expenses. And you could be left tied to a pile of large health care bills.

Five signs of a health insurance scam

Medicare and health insurance scams are common. Scammers are always looking for new ways to steal your money and personal information, but they use familiar techniques. Here are five signs that you may be facing a health insurance scam:

1. Scammers who tell you they work for the government and need money or your personal information. Government agencies do not call people out of the blue asking for money or personal information. No one who works for the government will ask you to verify your Social Security number, bank account, or credit card, or ask you to wire money or pay with a gift card or cryptocurrency.

If you have a question about Medicare or the Health Insurance Marketplace®, please contact the government directly:

  • Medicare: Medicare.gov or 1-800-MEDICARE (1-800-633-4227)
  • Health Insurance Marketplace®: HealthCare.gov or 1-800-318-2596

2. Scammers who tell you that you have to pay a fee to get a new Medicare card or you will lose Medicare coverage. But you never have to pay to get a new card. And you’ll never get an unexpected call from Medicare to say you’ll lose your coverage. It is a scam. Read more about Medicare cards.

3. Scammers trying to sell you a bogus medical discount plan. Medical discount plans charge you a monthly fee for discounts on specific medical products or services from a list of participating providers. These plans are not a substitute for health insurance. Although some medical discount plans offer legitimate discounts, others take people’s money and offer very little in return. So if you’re considering one of these plans, check each statement about the plan, including whether your doctor participates in that plan. And before you sign up, be sure to get the discount plan details in writing.

4. Scammers who want your sensitive personal information in exchange for a price quote. The official government website for the Affordable Care Act (ACA) is HealthCare.gov. This website allows you to compare health insurance plan prices, check your eligibility for health care subsidies, and begin the enrollment process. But the HealthCare.gov website will only ask you to enter your monthly income amount and your age to give you a price quote. Never enter personal financial information like your Social Security number, bank account, or credit card to get a health insurance quote. If you do, you will be exposed to Pre-recorded robocalls or robocalls or even worse, identity theft.

5. Scammers who want you to pay for help with the Health Insurance Marketplace. People who offer legitimate help with the Health Insurance Marketplace, also called navigators or assistants, aren’t allowed to charge you and won’t ask for your personal or financial information. For more information, visit HealthCare.gov and click on “Find Local Help”.

What to do before signing up for health insurance

While things to avoid have been covered so far, there are several steps you can take before signing up for health insurance. Here are some of the steps to keep in mind:

  • Visit a trusted source like HealthCare.gov to compare plans, coverage, and prices. HealthCare.gov and state health insurance marketplaces are the only places you’ll be guaranteed comprehensive coverage under the ACA.
  • Research the companies that offer you health coverage. Do an internet search by entering the name of the company and the words “complaint”, “scam” or “fraud”; if you search in Spanish, add “queja”, “estafa” or “fraud”. Read comments and look at other people’s opinions.
  • Find out if the plan is health insurance. All companies that sell health insurance must be licensed by your state insurance commissioner. If the company does not have a license, what it is selling is not insurance. Contact your state insurance commissioner’s office to find out.
  • Do not accept very general answers. If a vendor doesn’t give you specific details about coverage (for example, about deductibles, copays, and how to find in-network providers), take it as a red flag. The same applies if you don’t answer your questions. A legitimate plan sales representative should be able to answer your questions without directing you to another source of information such as a brochure or website. Get free help navigating the Health Insurance Marketplace at HealthCare.gov (click “Find Local Help”).
  • Insist on seeing a summary of benefits or a full copy of the policy you’re considering. Make sure everything the salesperson tells you about coverage is written in the summary of benefits.
  • If a salesperson says the plan is offered through a major insurer, check with that company. Some scammers use fake logos and promotional materials to appear credible. If an unknown company says it sells plans through a major insurer, check with that company to make sure it’s true.

Medicare scams

Medicare beneficiaries, and people who don’t have Medicare, too, are often targets of scams. You may have gotten a call from someone saying something like “Hi, I’m calling you from Medicare. Your coverage is about to be terminated.” Every year during open enrollment season (and many other times of the year), scammers posing as government employees show up calling people trying to steal their money and personal information. This is what you have to do:

  • Hang up the phone. If someone calls you claiming to be enrolled in Medicare and asking for your Social Security number or bank information to get a new card or new benefits, it’s a scam. Final point.
  • Never give personal information to anyone who calls you claiming to be on behalf of Medicare. You can’t trust your caller ID. Scammers can manipulate caller IDs to make it look like they’re calling you from a government agency even though they’re not. Before you give out any personal information, call 1-800-MEDICARE yourself to see what’s going on.
  • Report the call. Report these copycats by calling 1-800-MEDICARE and at ReportFraud.ftc.gov. The more information you give us, the more likely we are to combat and stop scams.

Another scam is related to Medicare Part D, which is an optional insurance program that covers prescription drugs for Medicare beneficiaries. You pay an insurance company a monthly premium for your Part D plan. In exchange for that premium, you use the insurance provider’s network of pharmacies to fill your prescriptions. To protect people, the law is very specific about how Medicare prescription drug plan providers must behave.

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By Cary Grant

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