AARP Hearing Center
Be Aware of Scams During Medicare Open Enrollment
Criminals want your personal information in order to perpetrate scams or defraud the federal health insurance program
Illustration: Rob Dobi
Key takeaways
- Medicare scams often increase during open enrollment, when people are reviewing and changing coverage.
- Scammers may pose as Medicare representatives and ask for your Medicare number, banking information or other personal details.
- It’s important to review your Medicare summary notices and look for suspicious claims.
Medicare has been a favorite target of scammers from virtually the moment the program was signed into law in July 1965. And a favorite time for criminals to perpetrate their scams is during the open enrollment period, when enrollees can make changes to their plans — from October 15 through December 7.
More Ways to Benefit
- Related Benefit 1
- Related Benefit 2
- Related Benefit 3
- Related Benefit 4
- Related Benefit 5
You may, for example, receive a phone call from someone claiming to be with Medicare. They may know your personal details, like your date of birth or address. Don’t let that convince you the caller is legitimate; scammers can easily purchase or obtain such data.
Unfortunately, many people don’t realize that Medicare won’t contact you out of the blue. Victims engage with these criminals, sometimes giving away personal financial information and Medicare details.
Criminals can then use that personal information to commit identity fraud (stealing money from victims’ bank accounts, among other potential fraud crimes). They might use the stolen Medicare number to make bogus claims, typically for medical equipment, genetic testing kits, diabetic supplies or deceptive hospice enrollments.
Video: Avoid Medicare Card Scams
“Your Medicare number is as valuable to a criminal as your Social Security number,” says Eva Velasquez, CEO of the Identity Theft Resource Center. “Guard it accordingly.”
Some criminals who defraud Medicare can also cause unexpected harm to patients. Mike Cohen, the headquarters operations officer at the Office of Inspector General, U.S. Department of Health and Human Services (HHS), says there are cases in which perpetrators bill Medicare in patients’ names for certain equipment, such as wheelchairs, or for lab tests that are a “lifetime” benefit. That means you only get the item or service once. And if that one opportunity is squandered due to fraud, the benefit is no longer available when the beneficiary actually needs it later.
Fraud, along with errors and abuse, causes Medicare to lose an estimated $60 billion annually — although, as the Senior Medicare Patrol notes, the exact figure is impossible to measure.
Common Medicare scams
New card offers. Criminals pretend to be from Medicare and tell beneficiaries that they will receive a new Medicare card with a chip or one that is plastic instead of paper. (Medicare cards are paper and none have a chip.) They may even say the new card includes additional benefits, such as a gift card.
“The scammer will say they need to confirm the Medicare ID and other personal information. In some cases, they tell the person they just need to provide banking account information to make sure they can continue paying their premiums,” says Kim McKenna, Senior Medicare Patrol (SMP) coordinator for the Washington State Office of the Insurance Commissioner.
Submission of false claims. “[Criminals] may use a person’s ID to contact a doctor’s office and request an order for medical equipment or tests, then submit claims without the beneficiary even knowing,” McKenna says. Scammers then get reimbursed by Medicare for the fake services.
Criminals take advantage of the fact that Medicare beneficiaries typically don’t receive a bill if Medicare and a supplemental policy cover the full cost, so victims may not even become aware of the fraud until services they didn’t receive appear on their quarterly summary notice.
This can result in hundreds of millions in fraudulent claims, with one recent case involving $644 million in billed charges. Criminals often use the stolen Medicare provider numbers of legitimate physicians to authorize these claims without their knowledge.
Free genetic testing scams. These have become increasingly common, according to Velasquez: Someone contacts you offering a free genetic screening, then collects your Medicare number and bills Medicare for tests that were never ordered by your physician and may never have been performed.”
Join Our Fight Against Fraud
Here’s what you can do to help protect people 50 and older from scams and fraud:
- Tell lawmakers to stop criminals from using crypto kiosks to steal from us.
- Sign up to become a digital fraud fighter to help raise awareness about the latest scams.
- Read more about how we’re fighting for you every day in Congress and across the country.
- AARP is your fierce defender on the issues that matter to people 50-plus. Become a member or renew your membership today.
Red flags for Medicare scams
Unexpected calls from someone claiming to work for Medicare. “The only time someone would receive a call from Medicare is if the beneficiary called Medicare first and scheduled a phone appointment with a representative,” McKenna says.
Offers of new or upgraded cards for a fee. Medicare cards are paper; there are no plastic Medicare cards or cards with chips. You can print a new Medicare card anytime from your online Medicare account. “No one would receive a new Medicare card unless they personally requested one from Medicare, like in a case where their ID has been compromised,” McKenna notes.
Requests for personal information. “Medicare will not call beneficiaries to ask for personal information or to update your information or give you a new Medicare card number,” says Rose Morales, an SMP fraud investigative analyst with California Health Advocates.
Callers who don’t clearly identify themselves. “Most scammers use generic phrases like ‘I’m calling from your health care provider’ or ‘I’m calling from Medicare Services,’ ” Morales says.
Threats of coverage cancellation. The caller says they’ll cancel your Medicare coverage unless you provide personal information over the phone. Medicare will never call you about canceling your coverage, and you will receive several bills and a delinquency notice in the mail before Medicare cancels your coverage for not paying Part B premiums.
Strange bills or charges. Take note if you receive a bill from a hospital or medical provider for care you didn’t receive, or you see a suspicious charge on your Medicare summary notice, which is your quarterly explanation of benefits from Medicare.
The ITRC also advises watching out for:
Offers of free equipment, screenings or services in exchange for your Medicare number.
Pressure to switch Medicare plans, especially with promises of unusually low premiums.
How to protect yourself from Medicare scams
1. Know how Medicare works. As noted above, Medicare won’t call you out of the blue with requests for information or new card offers. Find out more at AARP’s Medicare resource center.
2. Hang up immediately. If someone asks for your Medicare card number, hang up and call back using the number you know is associated with them. Don’t use a number they give you. (It’s good practice to never answer calls from people you don’t know.)
3. Keep your Medicare card at home. Only carry your Medicare card if you need it for a medical appointment. If you’re worried about what happens if you’re in an accident, you can keep a copy of the card in your wallet with the number crossed out. If you’re in an accident, you’ll only need to show that you have Medicare and your coverage start date; you can provide the number later.
4. Read your Medicare claims notices. Look for claims for services you didn’t receive or for duplicate claims. You can check your claims record by reviewing the notice you receive in the mail every three months, or you can sign up to receive monthly electronic statements. To see current claims, go to your online Medicare account.
5. Investigate odd charges. If you find suspicious charges on your Medicare summary notice, first contact your doctor’s office to ensure it isn’t just an error, and then contact Medicare or your local SMP to report the activity.
What to do if you’ve been targeted
Report the call to Medicare at 800-633-4227 and your state’s Senior Medicare Patrol at 877-808-2468. SMP volunteers can answer questions about suspicious charges and potential scams and help you report the fraud to Medicare and the U.S. Department of Health and Human Services’ Office of Inspector General, which investigates Medicare fraud. They can also help you determine whether your Medicare number has been compromised, and you should get a new one.
Report scams to the FBI’s Internet Crime Complaint Center (IC3).
For support and guidance, the trained fraud specialists at the free AARP Fraud Watch Network Helpline, 877-908-3360, can share information on what to do next and how to avoid future scams. The AARP Fraud Watch Network also offers free online group support sessions.
The key takeaways were created with the assistance of generative AI. An AARP editor reviewed and refined the content for accuracy and clarity.
AARP Membership
Join AARP for only $15 per year with automatic renewal. Get instant access to members-only products and hundreds of benefits, a free second membership, and a subscription to AARP The Magazine.
More From AARP
What to Do If You Become a Scam Victim
How one woman worked quickly — with help — to avoid being charged through PayPal
8 Scams That Senior Medicare Patrols Are Seeing
Old cons are recycled to take advantage of news reportsMedicare Flex Card Scams: Find Out the Truth
Trust your instinct. If something sounds too good to be true, it probably is