How to identify and avoid health insurance scams

Scams affect consumers of all ages, with Federal Trade Commission (FTC) reports showing the majority of fraud happens online for both younger and older adults. During Open Enrollment periods and times of unexpected life changes, scammers target health insurance customers to get valuable information, including Social Security and financial account numbers.  

Scammers are convincing, so learning how to recognize scams is important to help you avoid being a victim. Knowing how health insurance works and what options you have can help you identify health insurance scams and protect your personal information.

Health insurance scams typically aim to steal your personal information, financial data, or trick you into paying for a fraudulent plan. Scammers may impersonate government officials, health insurance agents, or representatives from well-known health insurance companies.  

Open Enrollment periods are a prime time for scammers to target consumers, when many people are shopping for health insurance. 

Knowing scammers’ common techniques can help you spot health insurance scams. Here are a few to watch out for.

One common tactic involves scammers impersonating Medicare or other government workers. They may call or email you saying they need your Social Security number, bank account information, or a fee for a new Medicare card to keep your coverage – which is not something you have to pay for.  

Government agencies, like the Centers for Medicare and Medicaid Services (CMS), will never call you unexpectedly to ask for your personal information or money.

Some scammers promote medical discount plans that are either fake or talk about them as if they are health insurance.  

While some legitimate discount programs do exist, they are not insurance – and they aren’t a substitute for health insurance. They offer reduced rates on services like dental, vision, hearing, or chiropractic care for a monthly fee. 

Be wary of any offer that promises significant discounts without clear details on what’s covered and which health care providers are part of the plan. 

Scammers may send fake emails, texts, social media messages, or even create ads designed to trick you into sharing sensitive information, such as your Social Security or health insurance ID numbers. These phishing attempts often look like they’re from legitimate companies, making it easy to fall for the trap. 

If you receive an unexpected message asking for personal details, don't respond or click on any links. Instead, visit the company’s official website directly or call their customer service line to verify the request.

Preventing health insurance scams starts with knowing what to look for. Follow these tips to keep your personal information safe and ensure you’re dealing with legitimate insurers. 

Before purchasing any health insurance plan, make sure the company is legitimate. You can confirm an insurance provider’s license through the NC Department of Insurance.

Scammers often reach out unsolicited by phone, email, or social media, offering too-good-to-be-true health insurance plans. Always be cautious of anyone who contacts you out of the blue, especially if they request personal or financial information immediately. Legitimate insurance companies won’t pressure you into making snap decisions. 

Health insurance scams often share common red flags: 

• Unsolicited offers of "free" health insurance 
• Requests for payment via gift cards or wire transfers 
• High-pressure sales tactics that push you to act fast 
• Unusual fees for things like updating your information or ensuring continued coverage 

If you notice any of these signs, it’s best to walk away. Scammers rely on creating a sense of urgency to trick their victims into making impulsive decisions. 

Never share your Social Security number, bank account details, or health insurance ID number with someone who contacts you unexpectedly.

If you’re unsure about the legitimacy of a call, hang up and reach out to the organization through official channels. Government agencies like Medicare will never ask for payment or personal information over the phone. 

If you think you’ve encountered a health insurance scam, act quickly. Report the fraud to the appropriate authorities to protect yourself and others: 

• Report Medicare fraud to the US Department of Health & Human Services Office of Inspector General or call 800-633-4227 (800-MEDICARE). 
• Report general health insurance fraud to the FTC. 
• For scams specific to North Carolina, contact the NC Department of Justice or call their consumer hotline at 877-566-7226 (877-5-NO-SCAM). 

Understanding how to identify and avoid health insurance scams is crucial in today’s digital age. By knowing the warning signs and protecting your personal information, you can avoid falling victim to fraud. Whether you’re purchasing insurance through the Health Insurance Marketplace®, Medicare.gov, or a private insurance company, always stay vigilant and verify any offers you receive. 

If you have any concerns or questions about health insurance scams, don't hesitate to reach out to trusted resources, such as your insurance company or the NC Department of Insurance.