Health insurance scams have become increasingly sophisticated, targeting both Medicare beneficiaries and people shopping for ACA marketplace coverage. According to the Federal Trade Commission, consumers reported losing over $12.5 billion to fraud in 2024—a 25% increase from the previous year. Knowing how to spot these scams can protect your health coverage, your finances, and your identity.
Scam activity spikes during enrollment periods when people are actively shopping for coverage:
• Medicare Open Enrollment: October 15 – December 7
• ACA Marketplace Open Enrollment: November 1 – January 15
However, scammers operate year-round, often targeting people during Special Enrollment Periods or claiming there's a "limited-time offer" that requires immediate action.
1. Government Impersonation Calls
Scammers pose as representatives of Medicare, Social Security, or the Health Insurance Marketplace. They may claim:
• Your Medicare coverage is about to be canceled
• You need to pay a fee for a new Medicare card
• You must "verify" your information to keep your benefits
• You're entitled to a refund or new benefit
Reality: Government agencies do not call out of the blue to ask for money, Medicare numbers, Social Security numbers, or bank information. Medicare cards are free and never expire.
2. Unauthorized Enrollment and Plan Switching
This has emerged as a major problem for ACA marketplace enrollees. In 2024, federal regulators received over 275,000 complaints about consumers being enrolled in health plans or switched to different plans without their knowledge or consent.
Rogue agents and brokers:
• Enroll people in ACA plans without their consent to collect commissions
• Switch existing enrollees to different plans without permission
• Use deceptive online ads promising free phones, gift cards, or cash in exchange for "signing up"
• Collect personal information through social media or misleading websites
The consequences: Victims may lose access to their doctors, face unexpected tax bills for subsidies they weren't eligible for, or find their coverage doesn't include the benefits they need.
3. Fake "Free" Gifts and Testing
Scammers offer gifts, medical supplies, or testing in exchange for your Medicare or personal information:
• Free DNA or genetic testing kits (not ordered by your doctor)
• Free medical equipment like braces, wheelchairs, or diabetes supplies
• Free health screenings at events or door-to-door
• Free phones, gas cards, or grocery cards for enrolling in a plan
Reality: Legitimate Medicare plans cannot offer expensive gifts in exchange for enrollment. Once scammers have your Medicare number, they can bill Medicare fraudulently, which can affect your ability to get supplies or services you actually need.
4. Fake Medical Discount Plans
Some companies advertise "health plans" with incredibly low premiums that aren't actually health insurance—they're discount programs that provide limited or no real coverage.
• They may not cover pre-existing conditions
• Benefits are limited to discounts at certain providers (who may not honor them)
• They don't qualify as minimum essential coverage under the ACA
• You're still responsible for full medical bills
Reality: If it sounds too good to be true, it probably is. Comprehensive health insurance has costs. Extremely low premiums usually mean you're not getting real insurance.
5. Phishing Emails and Fake Websites
Scammers create emails and websites that look like they're from Medicare, the Health Insurance Marketplace, or well-known insurance companies:
• Emails asking you to "verify" or "update" your information
• Websites with names like "ObamacarePlans.com" that imply government affiliation
• Ads featuring fake celebrity endorsements or AI-generated spokespeople
• Links that take you to fake enrollment sites that steal your information
Reality: The only official marketplace websites are HealthCare.gov and your state's official marketplace. Medicare's official website is Medicare.gov. Be suspicious of any ads that promise government benefits or feature celebrities.
Watch out for these warning signs:
High-pressure tactics: Claims that you must act "today" or "immediately" to get a special rate or avoid losing coverage
Unsolicited contact: Calls, texts, or emails you didn't request—Medicare plans can only contact you if you've asked for information or have an existing relationship
Requests for sensitive information: Asking for your Medicare number, Social Security number, or bank account information over the phone or through email
Claims of "calling from Medicare": No one from Medicare will call you to sell insurance or ask for personal information
"Free" offers with strings attached: Gifts, phones, or money in exchange for enrolling or providing your information
Unusually low premiums: Prices that seem dramatically lower than other options—this often means it's not real insurance
Vague answers: Agents who won't give precise details about deductibles, copays, networks, or what's covered
Pressure to provide information online: Requests to submit personal information through social media or unofficial websites
Go directly to official sources: Use HealthCare.gov for ACA marketplace plans and Medicare.gov for Medicare information. Don't click links in emails or ads.
Guard your numbers: Never give out your Medicare number, Social Security number, or bank information to anyone who contacts you unexpectedly.
Verify before you buy: Check that any insurance company or agent is licensed with the North Carolina Department of Insurance (ncdoi.gov).
Get everything in writing: Request full policy documents before signing anything. Review coverage details, deductibles, networks, and exclusions.
Hang up on robocalls: If you receive an automated call about Medicare or health insurance that you didn't request, hang up.
Check your accounts regularly: Log in to HealthCare.gov or Medicare.gov periodically to make sure no one has changed your enrollment without your knowledge.
Know the difference: Understand that discount plans are not the same as health insurance. Real health insurance is required to cover essential health benefits and cannot deny coverage for pre-existing conditions.
A trustworthy agent or broker will:
• Be licensed in your state and able to provide your license number
• Explain your options clearly without high-pressure tactics
• Answer your questions about deductibles, copays, networks, and coverage
• Provide documentation and give you time to review before enrolling
• Never ask for payment in gift cards, wire transfers, or cryptocurrency
• Protect your personal information and explain how it will be used
• Be available to help you after enrollment, not just during the sale
• Have verifiable reviews and a track record of service
If you suspect you've been a victim of health insurance fraud, take action immediately:
For ACA Marketplace Issues:
• Call the Health Insurance Marketplace Call Center: 1-800-318-2596
• Check your enrollment status at HealthCare.gov
• Request cancellation of any unauthorized coverage
• Work with a Navigator (free, unbiased help) to file a fraud complaint
• NC Navigator Consortium: 1-855-733-3711 or ncnavigator.org
For Medicare Issues:
• Call Medicare: 1-800-MEDICARE (1-800-633-4227)
• Contact the Senior Medicare Patrol: 1-877-808-2468
• Report to the HHS Fraud Hotline: 1-800-447-8477
For All Scams:
• Report to the FTC: ReportFraud.ftc.gov
• Contact the NC Department of Insurance: 1-855-408-1212
• File a complaint with the NC Attorney General's Consumer Protection Division
Navigating health insurance doesn't have to be risky. At Health Plans of NC, our licensed agents provide transparent, personalized guidance to help you find the right coverage—whether you're shopping for ACA marketplace plans, Medicare, dental, vision, or supplemental coverage.
Why Work With Us:
• Licensed in North Carolina with verifiable credentials
• Transparent about coverage options, costs, and limitations
• Never use high-pressure tactics or misleading offers
• Available year-round to answer questions and provide support
• Our services are free to you—insurance carriers pay us
Protect your health and your finances by working with agents you can trust. Contact Health Plans of NC today for honest, expert guidance on your health insurance options.
Call us at 1-800-797-0327 or request a quote today.
