Medicare fraud is a lucrative “business” for criminals, making Medicare scams targeting seniors an ever-present threat. Even as scams are detected and fraud rings shut down, scammers and fraudsters are constantly finding new ways to target Medicare beneficiaries. Their methods include deceptive tactics designed to steal your personal information, financial details, and even your rightful Medicare benefits.
You can protect yourself from Medicare fraud by staying aware of the current scams and deceptive tactics. Here are seven Medicare scams you need to watch out for in 2025 and how to avoid them.
1. Fake Medicare Representatives
In this scam, the fraudsters pose as “official” Medicare representatives saying you need to update your Medicare plan or information. If you’re newly eligible for Medicare, they may offer enrollment assistance. Others may pose as phony Medicare Advisors, offering free services, gifts, or additional benefits for completing your Medicare enrollment with them or choosing the Medicare Advantage Plan they claim to be selling. It’s all a ruse to get your personal information
How to Avoid It:
- Medicare will NEVER make unsolicited calls asking for your information or send unsolicited representatives to your home. If someone claims to be from Medicare and contacts you unexpectedly, it is most likely a scam.
- Ask for identification and verification. If you have a Medicare Advantage Plan, know your plan provider and ask the “representative” to verify themselves. Call your Advantage Plan provider yourself and ask about a call or visit you just received. Similarly, if you’ve been working with a Medicare Advisor, ask for their identity or a call-back number to verify it’s them.
- Never share your personal information with anyone you can’t verify! The scammers may ask for your Medicare number, Social Security number, or bank information under the guise of verifying your identity.
2. Supplemental Coverage Scams
All Medicare Part D prescription drug plans and supplemental Medigap plans are offered by private insurers. Fraudsters know this and use it to their advantage, offering seemingly legit plans at “unbeatable” rates. It’s all a scam to trick you into providing your personal and financial information. These scams typically come via robocalls, spam emails, and/or high-pressure salesman with misleading advertisements that promise “special” deals or “limited time” offers.
How to Avoid It:
- Only purchase insurance plans from licensed Medicare agents. You can verify any plan and/or agent through Medicare.gov or your state’s insurance department.
- Beware of any offer that sounds too good to be true—because it probably is! If that “unbeatable” rate is through an insurance provider you’ve never heard of, or that “discounted” plan is way lower than what’s being quoted by other agents and insurers, you need to pause, compare, and confirm through official Medicare channels. Scammers often pressure victims into making quick decisions—always take the time to verify first.
- Again, never provide personal, financial, or payment information over the phone, via email, or to an “agent” you can’t verify.
3. Medicare Open Enrollment Scams
Medicare Open Enrollment takes place every year from October 15 through December 7—and scammers know it. They take advantage of this period when legitimate insurers and agents are sending out plan enrollment communications to ramp up their own fraudulent marketing campaigns. Scammers may send official-looking letters, place high-pressure calls, show up at your door, and even create fake enrollment websites, all as a pretense for stealing your personal and financial information.
How to Avoid It:
- Be cautious of any unsolicited communications you receive. Do not trust third-party websites, unsolicited phone calls, or uninvited “agents” who show up at your door. If they use high-pressure sales tactics or promise “free” gifts or services, this is a huge red flag.
- Verify insurance carriers, agents, and plans directly with the insurance company or through Medicare.gov.
- Report misleading marketing materials, deceptive “agents,” or fake plans and insurers to Medicare or the National Association of Insurance Commissioners (NAIC).
4. Free, Discounted, or Unnecessary Medial Equipment Scams
This scam involves fraudsters calling, emailing, or sending mailers offering discounted or even “free” genetic testing kits, medical supplies or equipment, like mobility aids, lift seats, foot orthotics, joint braces, and catheters. These supplies are expensive, with Medicare beneficiaries responsible for 20% of durable medical equipment costs. Genetic testing kits must be ordered by a physician and deemed medically necessary for Medicare to cover the costs. So, the lure of “huge discounts” on these health services can be attractive bait—and scammers know it.
They claim the services they’re offering require no doctor’s pre-authorization and are fully covered, only for you to later receive unauthorized or exorbitant charges on your Medicare account. The scammers often bill Medicare for these “discounted” items at inflated prices or send a bill for equipment that you never actually receive. Plus, you’ve handed over your personal information to a scammer who may steal your identity.
How to Avoid It:
- Understand what your Medicare plan does and does not cover, and the out-of-pocket costs you’re responsible for. Medicare does not give away free medical equipment or services. For something to be fully covered, it must be prescribed or authorized by a doctor.
- Never provide your personal information or Medicare number to someone soliciting you over the phone, via email, or to an “agent” you can’t verify. These scammers often ask for your Social Security Number or Medicare number to “verify your eligibility” for the free service or discounted equipment they’re offering.
5. Offers of Cash Refunds, Gift Cards, and Free Gifts
This scam uses a similar lure of offering you something for “free” or as a “bonus” (like gift cards or “cash refunds” on your Medicare plan) in exchange for providing your information to a fraudster. In some cases, the offers of incentives, (e.g. cash payments, gift cards or “free” gifts) may be coming from legitimate insurers who are using these as inducements to get you to enroll in a particular Medicare Advantage Plan. While not a scam (the plan and insurer or legit), these tactics are illegal and can result in penalties for both you and the plan provider—and licensed insurers and brokers know this.
How to Avoid It:
- Offers of freebies are the hallmarks of a scam. Be wary of unsolicited calls, emails, or door-to-door “agents” promising free gifts, cash back, or other incentives for enrolling in “their” plan.
- Never allow yourself to be pressured into providing your personal information or signing up for something that you can’t verify. Don’t be afraid to ask for identification or a business card, and then independently check and verify that the “agent” and insurer are legitimate.
- Beyond verifying legitimacy, look for customer reviews and complaints. Unscrupulous agents often use these “free gift” tactics, so check online for agent or insurer reviews, ratings, and any Better Business Bureau complaints.
6. Misleading or High-Pressure Sales Tactics for Medicare Plans
Just like the offer of “free gifts” can be a red flag for fraudulent plans and agents, an unsolicited caller or “agent” at your door pressuring to “enroll now” can also be the tell-tail sign you’re about to be scammed! However, just like with those alluring “freebies,” some unscrupulous insurance agents or representatives for Medicare Advantage Plans may misrepresent the benefits, coverage, or costs, leading you to enroll in a plan that does not meet your needs or falls short of what was promised.
How to Avoid It:
- Again, never allow yourself to be pressured into providing your personal information or signing up for something just to get an “agent” off your lawn. If you find yourself being pressured by a sales pitch or the plan offered sounds too good to be true, it may be a scam by a fraudulent “agent” selling you a fake plan.
- Verify the legitimacy of the agent and insurer and look for customer reviews and complaints. While it may not be a scam, unscrupulous agents often use these misleading and high-pressure tactics to sell you a substandard Medicare Advantage Plan.
- Get plan information in writing. Ask for plan documents the agent can mail to you or email for you to download. This deters them from an instant sale and ensures you get the details of a plan’s benefits, coverage, and costs before you enroll in anything.
7. Fraudulent Billing
The endgame of the free and discounted medical equipment scam is to commit Medicare billing fraud. However, you can be the victim of fraudulent billing even if you don’t encounter fake “agents” or “too-good-to-be-true” offers. And you won’t even realize it until you get the bill! Besides outright scammers, legitimate (but dishonest) healthcare providers engage in fraudulent billing. They may forge billing codes (“upcoding” for more expensive services than what was provided) or charge Medicare for office visits and services you never received. It’s all an attempt to get higher payments from Medicare. Besides driving up healthcare costs, this fraud can result in a loss of benefits if it’s not caught quickly, as these fraudulent charges use up your Medicare benefits and could leave you unable to pay for needed health services.
How to Avoid It:
- Keep a record of your doctor visits and treatments. The best way to prevent and then catch fraudulent billing is by knowing what healthcare services you have received.
- Review your quarterly Medicare Summary Notices (MSNs) or Explanation of Benefits (EOBs) from your Medicare Advantage Plan. Cross-check these against your personal records and flag any unfamiliar charges or billing for services you did not receive.
- Report suspicious billing. If you find discrepancies in your statements and suspect fraud, contact your Advantage Plan provider or Medicare at 1-800-MEDICARE.
Concerned About Medicare Scams? Contact Wandacare
If you think you may be the victim of a Medicare scam or fraudulent billing, we can provide you with advocacy and assistance. Our experienced Medicare Advisors are licensed agents who always put your needs first! We’re not here to sell you a Medicare plan. We’re here to help you find the right Medicare plan, one that comes with our continual support, so you can always be confident in your coverage.
