How to Spot Scams in Health Care Coverage - dummies

By Lisa Yagoda, Nicole Duritz, Joan Friedman

Copyright © 2014 AARP. All rights reserved.

Since the Affordable Care Act (ACA) was passed in 2010, periodic waves of cons tied to health reform have reared their ugly heads. These include the sale of bogus insurance policies, as well as phone calls demanding sensitive personal information if you’re to receive a (nonexistent) Obamacare card or a new Medicare card.

Confusion over the ACA certainly helps the con artists. Many people are unaware of what they need to do (or don’t need to do) to comply with the ACA.

Some scammers have established fake websites claiming to sell ACA insurance. Others have renewed tried-and-true government impostor scams — delivered via phone call, fax, and e-mail — in which they claim to represent Medicare or other government agencies, sometimes just saying they’re “calling from Obamacare.” The goal is to get sensitive information for identity theft while pitching phony health plan enrollments.

Here are key pieces of information to help you keep scammers at bay:

  • If you have Medicare, you don’t need a new card or additional insurance because of the ACA.

  • As always, you can change your Medicare plan and prescription coverage during Medicare open enrollment from mid-October through early December each year, but no one from Medicare — or any other federal office — will make unsolicited contact via telephone, e-mail, fax, or a front-door visit.

    If anyone reaches out to you to ask for money or personal or financial information, including your Social Security/Medicare number, that person does not work for the U.S. government.

  • If you get health insurance at work, your employer should notify you — via official workplace correspondence — of what, if any, changes may occur. If you have private insurance through your employer, contact your human resources department; if you buy insurance on your own, contact your insurance provider with any questions.

  • You don’t need to pay anyone a single cent to help you sign up for health benefits, whether you’re applying for a public (government) program for the first time or shopping for private coverage.

  • Most people who need insurance are shopping on the federal or state Health Insurance Marketplace websites, but legitimate insurance vendors may reach out to you via phone or e-mail. (No one is required to purchase insurance via the Marketplace; you can still get a policy through an insurance agent or broker, or directly from an insurance company.)

    If someone calls you offering to sell you insurance, ask to receive information in the mail before you try to determine whether it’s a legitimate offer. If you receive an e-mail offering coverage, don’t click on any links included in the e-mail. Check first to make sure the vendor is legitimate and that the vendor actually sent the e-mail.

    To help answer questions about plans you may consider, as well as vendor and product legitimacy, you can contact the federal government’s hotline, 800-318-2596 (TTY 855-889-3425), or visit Do so before you provide sensitive details or sign anything.

  • A Health Insurance Marketplace website for any state ends in “.gov,” as does the federal website, If you receive communication suggesting that you visit a Marketplace website with an address that doesn’t end in “.gov,” stay away so you don’t accidentally download any malware onto your computer.

  • Although some states have enlisted advertisers and translators to help educate residents about new benefits for the uninsured, their role is strictly to educate consumers — not to sell policies.

  • Scare or rush tactics signal you’re dealing with a scammer. Claims of “limited-time offers” and “act now or lose benefits” are lies.

  • Scammers like to go after your medical records, called “fulls” in scammer jargon because they provide everything in one place for ID theft. Fetching as much as 50 times the rate of a Social Security number on online black markets, a stolen medical record opens the way for scammers to pose as you and to buy medications or to pay for medical treatments.

    And unlike in the case of credit card theft, victims may be responsible for these charges and may lose their coverage. So guard details of your medical history, treatments, or insurance — no matter what you’re being offered in return.

If you believe you’ve been contacted by a scammer, law enforcement officials need you to report your concerns. The ACA includes extra resources for fighting healthcare fraud. Contact your state insurance commission, your state attorney general, or local law enforcement about any suspicious promotions.

You can find contact information for your state insurance commission at NAIC. Report Medicare fraud to Medicare at 800-MEDICARE (800-633-4227). You can find more information about healthcare fraud and scams at AARP.