Health Insurance Scams

Health insurance scams are common. Many scammers try to take advantage of the confusion around health insurance laws and insurance plans.

Health insurance scams tend to increase during annual open enrollment periods. Some scams also target certain groups of people like older adults, veterans, or immigrants.

If you get a caller from the Marketplace

The Marketplace sometimes calls people to get more information for their application. But they will never ask you for payment to apply for or keep your coverage.

Here are some important things to remember about the Marketplace:

• Calls come from 1-855-997-1890 or 844-477-7500. It might also show as Health Insurance MP or Ins Marketplace on your caller ID. But scammers can fake caller ID, so don’t use this alone to confirm that a caller is real.
• Anyone calling from the Marketplace will give you their first name and ID number.
• If you’re not sure if someone calling is really from the Marketplace, you can hang up and call the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325).
• The Marketplace has real assisters that help people find a plan. This help is always free, and you will never be asked to pay. Learn more about how to find a free, trained Marketplace assister.

Marketplace callers will never ask you for your:

• Medical history or condition (you might be asked for medical documentation if you’ve applied for certain Marketplace exemptions)
• Marketplace account password or security code
• Bank name or account number

If someone asks you for more documents, it’s safest to upload them through your Marketplace account.

 Medicare and Medicaid scams

A common scam is when someone calls you and tells you your Medicare or Medicaid benefits are going to be cancelled. They might ask you for information like your Social Security number, Medicare or Medicaid ID, or bank account information. Scammers might threaten you with legal action or major fees if you don’t renew right away over the phone. This is a scam.

Legitimate people from Medicare and Medicaid don’t usually call or email people for this information. It’s usually sent in a letter in the mail. And you can renew online, by mail, or in person. There is never a fee to renew Medicare or Medicaid.

 Medical discount plans

 Medical discount plans are not health insurance. These plans charge a monthly fee for “discounted” services or products. Discount plans also don’t cover health services such as surgery, chemotherapy, imaging tests, radiation, preventive care. If someone contacts you and pressures you to sign up quickly for a medical discount plan, it could be a scam.

These plans may have different names like affordable plans, supplemental plans, or premium plans. They may also have other hidden fees or extra charges. 

How to spot a scam

The safest ways to sign up for health insurance coverage are:

• Through you or your spouse’s workplace
• Through the Marketplace

If you want information about non-Marketplace plans, be cautious with things like:

• Very low premiums
• A push for you to sign up today
• Very aggressive salespeople. They may try to get around your questions, and often don’t have the full policy details in writing. Some offer you coverage only if you join an association, union, or other group.

 Here are some other things you can do to protect yourself from scams:

• Don’t give out money, credit card information, birth dates, Social Security numbers, or bank account numbers unless you are sure exactly who you are giving it to and why.
• Ask for a plan that covers required essential benefits under the Affordable Care Act.
• Call your state insurance department (see below) to make sure the plan is licensed in your state. You can also ask if the plan has had complaints made against it.
• Check with your doctors, your pharmacist, and any facilities you use, to be sure they accept the plan you’re considering.
• Review your claims and explanation of benefits (EOB). If you see any services, tests, or medicines you don’t recognize, call your doctor’s office and insurance company right away.
• Scammers often tell you to pay them in a specific way (gift card, wire transfer, etc.)
• Scammers usually demand you act quickly.
• If you’re ever unsure, hang up and called the organization directly.
• If someone asks you to hit a button to stop getting calls, don’t. Just hang up.
• Never give personal or financial information just to get a quote on a plan.
• Don’t click on any links in text messages or emails that you don’t recognize.

Check out the Federal Communications Commission’s scam glossary for a list of common scams and how to spot them.

What do I do if I think I’ve been scammed?

• File an insurance complaint with your state’s Insurance Commission by contacting the National Association of Insurance Commissioners online, or call them at 1-866-470-6242.
• Report fraud to the Federal Trade Commission.
• Call 1-877-FTC-HELP (1-877-382-4357) or notify the FTC online.
• Report Medicare scams at Medicare.gov or call 1-800-633-4227.