Health insurance is something every American should have, but navigating the healthcare marketplace can be overwhelming. Scammers are all too aware of that, and look for any loopholes in people’s knowledge that they can exploit in order to sell fraudulent “plans” to people.
Health insurance scams are especially prevalent in the open enrollment period for Medicare and health plans. They can take many forms, and aren’t always as obvious as you might think. Here, we’ll go over some of the more common health insurance scams people fall victim to, and tell you what you can do to avoid them.
As technology evolves, scammers have upped their game. There are several ways in which they try and dupe people out of their money. In 2018 just one company stole millions from people looking for healthcare coverage according to the Federal Trade Commission (FTC) which handles consumer fraud complaints. A few of the most prevalent are:
fake websites promising unusual discounts on insurance plans,
robocalls or live calls from fake sales agents, and
door to door salespeople claiming to be from “the government” and authorized to sell insurance.
Fake websites can be especially dangerous. They don’t always look shoddy, and often incorporate the logos of legitimate organizations. A good way to figure out if a website is a scam is to look at it closely. Scroll to the bottom of the page and look at the copyright. What company is it? Have you heard of them? If a search reveals nothing, or reports of a scam, steer clear. These websites will often require you to enter personal information in exchange for a quote. Don’t take the bait. If you give them that information, you’re setting yourself up for a barrage of sales calls and possible identity theft.
Robocalls are another big problem. Tracking website YouMail, which has been logging robocalls since 2015, records 5.2 billion robocalls placed just in the month of March, 2019. Almost half those calls were scams: just over 47%. Scam calls will leave an urgent-sounding message designed to scare the potential victim into calling. If someone should call back the scammer on the other end of the line will say they work with “the government” or “the law,” and demand payment.
Lastly, if anyone comes to your home uninvited and tries to sell you health insurance, don’t listen to them. No one from the health insurance marketplace will come to your door unsolicited.
Television ads and mailers with offers of low cost health coverage, no deductibles, and free medical apparatus like back and knee braces are another common method scammers use to glean personal information from consumers. Check these offers very carefully; more often than not, they’re a scam. That supposed low-cost health care plan is likely to be a discount plan dressed up as coverage, or a fake plan that provides no coverage at all.
Being a savvy consumer requires some extra effort, but it’s well worth it to make sure you’re getting the insurance you bought. When looking for plans, sticking with the healthcare.gov website is your safest bet for finding a legitimate health plan. Plans listed will have full explanations of benefits that you can look through to help you decide if they provide adequate coverage.
As we said above, be on the lookout for fake websites dressed up to look like the real thing. Look for a domain with .gov at the end of the url, and double check that website’s credentials by looking at the copyright and browsing the ‘about’ section.
The official ACA site also offer free help from local agents to assist people when buying healthcare. Never, ever pay someone to help you get coverage, or to receive a Medicare card. These services are provided free of charge. Should you choose to contact a representative, take down their full name and agent ID number. You can search that information on your state insurance commissioner’s website to make sure they’re legitimate. When speaking with a representative and deciding on a plan, ask them for a full explanation of benefits. If the person you’re speaking with won’t provide one, they aren’t a legitimate agent. Do not trust someone who tells you a service usually costs more, but that they know how to bill Medicare so you won’t have to pay for it.
Once you’ve chosen a plan, make sure to go over your statements carefully. Whenever you use your benefits, you’ll receive an ‘explanation of benefits’ document listing the services provided, when, and by whom. Go over this and make sure that everything matches up correctly to avoid billing fraud.
If you suspect you’ve been contacted by a scammer or fallen victim to a scam, there are several agencies you can contact. If you suspect a scammer is local, you can also contact your local police department. You can also report fraud to the Health and Human Services Office of the Inspector General at 1‑800‑HHS‑TIPS (1‑800‑447‑8477) or TTY: 1‑800‑377‑4950.