Medicare Open Enrollment Scams
Why every October–December brings a wave of Medicare scam calls — and exactly how to choose a legitimate plan with no risk.
How the Scam Works
Medicare's Annual Open Enrollment Period runs from October 15 to December 7. During these 8 weeks, beneficiaries can change Medicare Advantage plans, switch Part D prescription plans, or move between Original Medicare and Advantage. It's a busy season — and scammers know it. The phones light up with fake "Medicare advisors," "licensed agents," and "plan specialists" all promising a better deal.
The scammer's pitch may sound friendly: "This is John from Medicare. There are new plans this year that offer extra benefits — dental, vision, hearing, a flex card, free gym membership. Let me run your information and see what you qualify for." Sometimes they identify themselves as being from "Medicare," "United Healthcare Medicare," or "Senior Benefits" — anything that sounds official.
The "agent's" real goal varies:
- •Identity theft. They want your Medicare number, Social Security number, date of birth, and bank info.
- •Plan switching for commission. They'll enroll you in a different plan (often with worse coverage for you) just to earn a $300–$700 commission.
- •Misleading "marketing" enrollment. Real licensed agents who use high-pressure tactics or omit important details — technically legal but deceptive.
- •Phony "verification" of your information to create a fake plan enrollment without your consent.
CMS (the federal agency that runs Medicare) has rules limiting how plans can market to you. Cold-calling beneficiaries is illegal unless you have a pre-existing relationship with the company. Door-to-door sales are also prohibited.
Real-World Example
📅 Real Case
During the 2024 Open Enrollment, an 80-year-old woman in Arizona received a call from someone claiming to be "Mark from Medicare benefits." He promised her a new plan with $200 monthly grocery credits and free dental work. She gave him her Medicare number and address to "verify her eligibility." When she went to her doctor in January, the office told her she had been switched from her old plan to a different Medicare Advantage plan — one that didn't include her primary care physician or her cardiologist. She was locked into the new plan for the rest of the year, paying out-of-pocket for the doctors she had been seeing for decades.
Open Enrollment Rules — Know Your Rights
- ✓Cold calls from Medicare plans are illegal. Plans cannot contact you unless you initiated the relationship.
- ✓Door-to-door visits without invitation are illegal.
- ✓Agents cannot offer gifts worth more than $15 to entice you to enroll.
- ✓Agents cannot enroll you on the same call they introduce themselves on — you must have time to review.
- ✓You can change your mind. If you enroll in a Medicare Advantage plan during Open Enrollment, you have until December 7 to switch — or use the Medicare Advantage Open Enrollment Period (Jan 1–Mar 31) to change once more.
- ✓Agents must be licensed in your state. Ask for their license number and verify it with your state insurance department.
Warning Signs
- •Unsolicited call "from Medicare" or about Medicare plans.
- •"Free" benefits — gym membership, grocery cards, money on a debit card — used as bait.
- •Pressure to decide on the spot.
- •Requests for Social Security, Medicare, or bank info early in the call.
- •Caller refuses to give a license number or only offers a first name.
- •Person at your door claiming to "help with Medicare" — illegal.
- •TV ads claiming "Medicare's new $148 benefit" — these mislead you about general Medicare Advantage flex card offers.
How to Protect Yourself
- ✓Hang up on unsolicited Medicare calls. Real plans cannot call you cold.
- ✓Compare plans yourself at Medicare.gov/plan-compare.
- ✓Use SHIP (free, unbiased Medicare counseling). Find your state at shiphelp.org or call 1-877-839-2675.
- ✓Verify agents. Ask for their National Producer Number (NPN) and check at nipr.com.
- ✓Verify your doctors are in-network before switching plans. Even a $0-premium plan is bad value if it doesn't cover your current doctors.
- ✓Verify your medications are covered on the new plan's formulary.
- ✓If you were enrolled without consent: Call 1-800-MEDICARE immediately. You may qualify for a Special Enrollment Period to undo the change.
- ✓Report Open Enrollment scams to your local Senior Medicare Patrol and the HHS Office of Inspector General.
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