Health Insurance Scams: Warning Signs

Scammers pretending to be from health insurance providers or the government can trick you into giving up valuable information, which can lead to identity theft. The best way to protect yourself from health insurance scams to know the warning signs.

What to look out for:

They claim they’re from the government

The government will never call you directly.* If a scammer calls and says they are from Medicare or any other government agency, hang up. If you feel the need to verify the call, hang up and call the government agency directly:

• Medicare: Medicare.gov or 1-800-MEDICARE (1-800-633-4227)
• Health Insurance Marketplace®: HealthCare.gov or 1-800-318-2596
• Private Insurance: Find the number on your insurance card, account statement, or at their website

*Exception: After filling out an application at HealthCare.gov, a representative will call and ask for verifying information from your application. They will give you their name and agent ID number. Write both down. If they refuse to give you a name or ID number, hang up.

They will threaten to cancel your coverage

Threats are a common tactic to scare you into doing something rash. They might say your card is about to expire or you are about to lose benefits. The government will never call you to make this alert. Hang up and report the call.

They have a familiar phone number

If caller ID shows a familiar name or phone number, be wary. Health insurance scams can “spoof” or fake numbers to mimic people and organizations you trust. Never answer a phone number you can’t confirm. If you do answer, do not answer any questions. If the call tells you to hit a button to stop getting calls, hang up. To confirm a phone call was legitimate, call the organization directly.

They claim you owe money

Scammers will say you owe a bill in order to get your bank information and steal your money. Do not give your credit card or bank information to anyone over the phone that you do not know. You will never need to pay for a new Medicare card. You will also never have to pay someone to help you find coverage. Legitimate assistants—sometimes called Navigators or Assisters—are not allowed to charge you for help with the Marketplace.

They ask for personal information

If a scammer asks for your Medicare number, Social Security number, passwords, or bank information, hang up. They will often ask it under the guise of “verifying” your identity or to offer a quote or a discount on coverage. Never give your personal information out to someone you do not know. Your healthcare plan already has this information and will not ask you to provide it.

They will offer fake insurance plans or perks

Scammers will often lie and say they are from legitimate healthcare plans. They may offer gifts, discounts, or “free” prescriptions or services in exchange for your information. Never give out your information to receive a promised offer. Always remember: if it sounds too good to be true, it probably is.

Callers will sometimes offer medical discount plans. These plans charge you a monthly fee for special discounts and services. Despite their claims, they are not a substitute for insurance. Some are legitimate, but many take your money and give you little to no benefit. If you are interested in a medical discount plan, do your own research and call the plan directly after confirming that your doctor is covered. Never sign up for a plan without getting the details in writing first.

Never buy durable medical equipment such as wheelchairs, scooters, or walkers from an unsolicited caller, even if they claim to have gone through your plan or doctor’s office. Selling medical equipment via unsolicited calls is illegal. This is another scam to get your personal financial information.

What should I do?

Monitor

Double-check your health plan statements for any incorrect or fraudulent charges or claims. Look out for suspicious line items such as charges for services or items you never received, such as an appointment you never had or medical equipment you never got. Note also if a provider billed you twice for a service or item you only received once, for example: charging you for two appointments on a day you only had one. If you need to authenticate any items on your bill, call the number on your billing statement.

Hang up

When in doubt, hang up. Call the government agency or health plan provider directly to verify the call was legitimate. Make sure to look up the official customer service number at the provider’s website or on your account statement.

Report

If you think you have been targeted by a health insurance scam, report the call:

• Medicare scams: call 1-800-MEDICARE (1-800-633-4227)
• Health Insurance Marketplace®: call 1-800-318-2596
• Health insurance and medical discount scams: visit ReportFraud.ftc.gov
• Scammers claiming to be from your health plan provider: call the customer service number on their website, on your insurance card, or on your billing statement