Medicare and Health Insurance Scams: Warning Signs and Reporting

Medicare and health insurance scams usually start with an unexpected call, ad or visit offering something "free" (a genetic test, a back or knee brace, medical supplies) or warning that your Medicare card or coverage is about to change. Often the scammer wants your Medicare number or your enrollment rather than a payment: HHS-OIG warns that "free" genetic-test offers are made "to obtain their Medicare information for identity theft or fraudulent billing purposes." Medicare's own rule is simple: it "will never call you to sell you anything or visit you at your home."

If you already gave out your Medicare number or said yes to something: call 1-800-MEDICARE (1-800-633-4227), watch your Medicare statements for services or equipment you never got, and call your Senior Medicare Patrol at 1-877-808-2468 for help. If your Health Insurance Marketplace plan was switched, or you were enrolled without your consent, call the Marketplace Call Center at 1-800-318-2596.

Information last verified on October 3, 2026. This article has not been reviewed by a licensed lawyer.

Jurisdiction scope: This guide covers US federal law and federal agency guidance on Medicare scams and health insurance scams: guidance from Medicare.gov, HHS-OIG, the FTC and CMS, the federal health care fraud statute (18 U.S.C. § 1347) and the Medicare Advantage marketing rule (42 C.F.R. § 422.2264). The Marketplace facts below cover the federal Marketplace (HealthCare.gov); states that run their own exchange have their own call centers and rules. State insurance law, state Medicaid fraud units and private employer coverage are not covered. For medical records, credit reports and other fallout from a stolen Medicare number, see our guide to medical identity theft.

How to spot a Medicare or health insurance scam

The common thread is an unsolicited contact that asks for your Medicare number, your Social Security number, or your agreement to a plan or product. Medicare.gov tells beneficiaries not to give their Medicare card, Medicare Number, Social Security card or Social Security Number "to anyone except your doctor or people you know should have it (like insurers acting on your behalf or people who work with Medicare, like your State Health Insurance Assistance Program (SHIP)."

The Senior Medicare Patrol (SMP) Resource Center, which says it is supported by financial assistance from the Administration for Community Living at HHS, lists common examples of suspected Medicare fraud or abuse that include "Providing unsolicited supplies to beneficiaries," "Offering or receiving a kickback (bribe) in exchange for a beneficiary's Medicare number," and "Requesting Medicare numbers at an educational presentation or in an unsolicited phone call."

A call about a new Medicare card or your Medicare number

The FTC describes this script: "Scammers say you need to pay a fee for a new Medicare card or you'll lose your Medicare coverage. But you never need to pay for a new card. And Medicare will never call out of the blue to say you'll lose coverage."

Medicare.gov says that Medicare, or someone representing Medicare, "will only call and ask for personal information in limited situations (like an agent or representative returning your call after you've joined a plan, reported fraud, or left a message for Medicare)." A cold call asking you to confirm your number is not one of those situations. For the wider pattern of callers posing as federal agencies, see our guide to government impersonation scams.

"Free" genetic tests, braces and medical supplies

These offers are rarely free. Someone bills Medicare for them using your number. HHS-OIG's 2019 alert on genetic testing says: "Scammers are offering Medicare beneficiaries "free" screenings or cheek swabs for genetic testing to obtain their Medicare information for identity theft or fraudulent billing purposes." It adds that they work "through telemarketing calls, booths at public events, health fairs, and door-to-door visits."

The cost can land on you. The same alert warns: "If Medicare denies the claim, the beneficiary could be responsible for the entire cost of the test, which could be thousands of dollars."

Braces follow the same model. HHS-OIG's 2019 brace alert says fraudsters "may call beneficiaries directly to offer braces" or use TV and radio ads, and warns: "If a beneficiary has received unwanted or unneeded braces, and that equipment is billed to Medicare, then Medicare may deny a brace that the beneficiary needs in the future." Its advice: "If you receive a call from someone offering you a free brace that will be billed to Medicare, hang up immediately."

These are not old problems. In its June 30, 2025 national takedown, the Department of Justice announced charges against 49 defendants "in connection with the submission of over $1.17 billion in allegedly fraudulent claims to Medicare resulting from telemedicine and genetic testing fraud schemes." In one Southern District of Florida case, prosecutors allege that "Medicare beneficiaries were allegedly targeted through deceptive telemarketing campaigns and then fraudulent claims were submitted to Medicare for durable medical equipment and genetic tests." These are charges, not convictions.

SMP and HHS-OIG also track related schemes involving remote patient monitoring, telehealth, hospice, cardiovascular testing and urinary catheters.

Pressure to switch plans during open enrollment

The FTC issued a warning about health insurance scams ahead of the 2026 open enrollment season, and its consumer guidance notes: "You have from October 15 to December 7 of every year to decide on a plan for the following year."

Medicare.gov's rule for consumers is: do not "Join a Medicare health or drug plan over the phone, unless you called and asked for help." The FTC adds that "Medicare Part D plan representatives may enroll you on the phone only if YOU call them" and "Medicare Part D providers may come to your home only if you've invited them."

The Marketplace season is different. HealthCare.gov lists "November 1: Open Enrollment starts" and "January 15: Open Enrollment ends." Knowing which season applies to your coverage makes a pressure call easier to spot.

A broker changes your Marketplace plan without your consent

This scam involves Marketplace (ACA) coverage rather than Medicare. Some agents and brokers have enrolled people in Marketplace plans, or switched their plans, without permission. CMS calls these an "unauthorized enrollment" and an "unauthorized plan switch." What CMS has reported and done about it is covered in the section on unauthorized Marketplace enrollment below.

Fake websites, sponsored ads and plans that are not insurance

The FTC warned in September 2026 that "Bad actors often use web addresses that look similar to government website addresses. They also use keywords and official-looking logos to make you think you're at the real Healthcare.gov or Medicare.gov when you're not." It also says that "scammers and dishonest businesses sometimes pay to appear at the top" of search results, so look for small "Ad" or "Sponsored" labels.

The FTC's tip: "Type the name of the website directly into the search engine." For Medicare, that is Medicare.gov or 800-633-4227; for the Marketplace, HealthCare.gov or 800-318-2596.

Watch for products sold as coverage. The FTC says "Medical discount plans ... are not insurance and they're not a substitute for health insurance," and "All companies selling health insurance must be licensed by your state insurance commissioner." It also warns about people charging for Marketplace help: legitimate Navigators or Assisters "are not allowed to charge you and won't ask you for personal or financial information." And "HealthCare.gov will only ask for your monthly income and your age to give you a price quote."

Offers of money, gifts or payment by gift card

Medicare.gov says not to "Accept offers of money or gifts for free medical care," and not to "Allow anyone, except your doctor or other Medicare providers, to review your medical records or recommend services."

When a caller does ask for payment, the FTC's rule applies: "No one from the government will ask you to verify your Social Security, bank account, or credit card number, and they won't ask you to wire money or pay by gift card or cryptocurrency."

What to do right now

1. Hang up or close the door. You do not have to argue, confirm anything or explain. If you are unsure whether a call was real, call 1-800-MEDICARE (1-800-633-4227) yourself.
2. Refuse kits you did not order. HHS-OIG says: "If a genetic testing kit is mailed to you, don't accept it unless it was ordered by your physician. Refuse the delivery or return it to the sender. Keep a record of the sender's name and the date you returned the items."
3. Write down what happened. Note the date, the caller's name and number, the company name and what you were offered. Reporting is easier with details.
4. If you gave out your Medicare number, call 1-800-MEDICARE, then check your claims (see the next section). Your local Senior Medicare Patrol (1-877-808-2468) can assist with questionable charges.
5. If you also gave your Social Security number or bank details, follow our guide to what to do when a scammer has your information.
6. If you paid a fee for a card, a plan or a product, contact your bank, card issuer or payment app right away. Your rights depend on how you paid; see how to get money back after a scam.
7. If your Marketplace plan changed without your consent, call the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325).
8. Report it to the channels listed below.

If the person targeted is an older parent or relative, our elder fraud guide covers how families can help and the elder-specific hotlines.

How to read your Medicare Summary Notice

The Medicare Summary Notice (MSN) is your record of what was billed to Original Medicare in your name, which makes it the place to spot fraud. Medicare.gov describes it this way: "It's not a bill. It's a notice that people with Original Medicare get in the mail at least twice a year for their Medicare Part A and Part B-covered services."

How often it comes. "You'll get your MSN every 6 months if you get any services or medical supplies during that period." If you sign up for electronic MSNs, "you'll get an email with a link to your MSN for any month you have a processed claim."

What it shows. According to Medicare.gov, the MSN shows:

• "All your services or supplies that providers and suppliers billed to Medicare during that period"
• "What Medicare paid"
• "The maximum amount you may owe the provider"

What to look for. Medicare.gov says to "Keep your receipts and bills, and compare them to your MSN to be sure you got all the services, supplies, or equipment listed." Its fraud page adds: "Compare the dates and services on your calendar with the Medicare statements you get to make sure you got each service listed." Red flags include:

• a genetic test, brace, catheter or other equipment you never ordered or received
• a provider or supplier you have never heard of
• services on dates you were not seen
• more items, or more expensive items, than you received

You do not have to wait six months. Medicare.gov suggests you "Create a secure Medicare.gov account to view your Original Medicare claims as soon as they're processed to help spot mistakes sooner."

If something looks wrong. HHS-OIG says: "Contact your health care provider first to see if it's a mistake. If your issue is not resolved by your provider, report the questionable charges to 1-800-MEDICARE or contact your local Senior Medicare Patrol." If Medicare denied an item, Medicare.gov says "The last page of the MSN gives you step-by-step directions on when and how to file an appeal."

Medicare.gov describes the MSN as a notice for people with Original Medicare. If you are in a Medicare Advantage or Medicare drug plan, you can also report suspected plan fraud to the I-MEDIC line listed below.

Unauthorized ACA Marketplace enrollment and plan switching

Some agents and brokers have moved people into Marketplace plans they never chose, or enrolled people who never asked for coverage. CMS has reported on the problem since 2024 and has taken several actions, each with its own date.

The scale, as CMS reported it on October 17, 2024: "From January 2024 through August 2024, CMS received 90,863 complaints that consumers had their FFM plan changed without their consent (also known as an 'unauthorized plan switch')" and 183,553 complaints "that consumers were enrolled in FFM coverage without their consent (also known as an 'unauthorized enrollment')." FFM means the Federally-facilitated Marketplace. These are two separate complaint counts.

What CMS changed in 2024:

• "Beginning July 19, 2024, CMS began blocking agents and brokers from making changes to a consumer's FFM enrollment unless the agent or broker is already associated with the consumer's enrollment." A new agent has to bring the consumer onto a three-way call with the Marketplace Call Center.
• "From June 2024 through October 2024, CMS suspended 850 agents and brokers' Marketplace Agreements for reasonable suspicion of fraudulent or abusive conduct."

What CMS reported on September 22, 2026:

• "On August 31, 2026, CMS canceled approximately 315,000 enrollments covering over 760,000 individuals after confirmation that these enrollments were unauthorized."
• CMS "expects this will result in a return of approximately $2.2 billion in advance payments of the premium tax credit (APTC)."
• "Since January 2026, CMS has sent termination notices to over 200 non-compliant agents and brokers."
• CMS announced a "temporary moratorium on the registration of agents and brokers for 2027 who do not have an active Exchange Agreement for 2026."
• CMS said that "in advance of Open Enrollment, CMS will implement a requirement for electronic consumer authorization before an agent or broker can take any action on an application or enrollment." The fact sheet described this as an upcoming step; we have not confirmed that it is in effect.

What to do. CMS says: "Consumers who believe they may have been the victim of unauthorized FFM agent or broker activity should call the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325)". Call if you get a notice from a plan you did not choose, or see a change to your enrollment you did not ask for. These CMS actions apply to the federal Marketplace; if your state runs its own exchange, contact that exchange.

The FTC has also gone after lead sellers and marketers. Its June 2026 release lists a 2025 action under the Impersonation Rule against "MediaAlpha (government imposter scheme to sell health insurance)," and a complaint filed in April 2026 against Innovative Partners "alleging the operators impersonate the government and large insurance carriers to deceive consumers seeking health insurance into buying supposedly comprehensive PPO plans that do not offer the coverage they seek." The Innovative Partners claims are allegations.

Where to report Medicare and health insurance scams

Use the channel that fits what happened. Reporting to more than one is fine. For every other kind of scam, see our full guide to where to report a scam.

1-800-MEDICARE. Medicare.gov says: "If you suspect fraud call 1-800-MEDICARE (1-800-633-4227) or Report Medicare Fraud online." The FTC says "The Medicare phone line is open 24 hours a day."

HHS-OIG. The Office of Inspector General of the Department of Health and Human Services runs the fraud hotline for suspected Medicare fraud. Medicare.gov's "Report Medicare Fraud online" link goes to HHS-OIG's report-fraud page.

Senior Medicare Patrol. HHS-OIG directs people with questionable charges their provider will not fix to "contact your local Senior Medicare Patrol for assistance: 1-877-808-2468 or www.SMPResource.org." Medicare.gov also names your State Health Insurance Assistance Program (SHIP) among the people who work with Medicare and may properly have your Medicare number.

FTC and state attorney general. For health insurance scams, the FTC says: "Tell the FTC at ReportFraud.ftc.gov and your state attorney general. If the scam involves Medicare, report it at Medicare.gov or 800-633-4227." For impersonators, it says to report "at 1-800-MEDICARE and ReportFraud.ftc.gov."

Federal law on Medicare and health insurance fraud

Health care fraud. The central federal statute, 18 U.S.C. § 1347, applies to anyone who "knowingly and willfully executes, or attempts to execute, a scheme or artifice" to defraud any health care benefit program, or to obtain money or property owned by or under the control of one "by means of false or fraudulent pretenses, representations, or promises," in each case "in connection with the delivery of or payment for health care benefits, items, or services." The penalty is up to 10 years in prison, up to 20 years if the violation results in serious bodily injury, and up to life if it results in death. A scheme that uses your Medicare number to bill for tests or equipment you never needed is the kind of conduct this statute targets.

Impersonation. The FTC's Impersonation Rule (16 C.F.R. Part 461) prohibits materially and falsely posing as a government entity or officer, and a separate section covers impersonating businesses, such as insurance carriers. The FTC used it in the health insurance actions described above.

Medicare Advantage marketing. Under 42 C.F.R. § 422.2264(a)(2), Medicare Advantage organizations "may not do any of the following if unsolicited," including "door to door solicitation" and "telephone solicitation (that is, cold calling), robocalls, text messages, or voicemail messages." This rule binds the plans and the agents and brokers marketing them; it is a reason an unsolicited sales call for a Medicare Advantage plan is itself a warning sign.

Recorded fake consent. In one Northern District of Illinois case in the 2025 takedown, DOJ alleges that the defendants "used artificial intelligence to create fake recordings of Medicare beneficiaries purportedly consenting to receive certain products." This is an allegation. It is one more reason not to say "yes" to anything on an unsolicited call.

Getting money back

Many Medicare lures, like free test and brace offers, are after your Medicare number rather than your money. The loss shows up as fraudulent claims billed in your name, and your protection is spotting and reporting those claims through your MSN, 1-800-MEDICARE and SMP. If a claim is denied and you are billed, use the appeal directions on the last page of your MSN.

If you did pay (a "fee" for a card, a premium for a fake plan, or anything by wire, gift card or crypto), contact the payment company first and quickly. Our guide to getting money back after a scam explains your rights by payment method.

Related guides

• Scams and fraud: the complete guide
• Medical identity theft
• Elder fraud: scams targeting seniors
• Government impersonation scams
• Where to report a scam
• How to get money back after a scam
• Grandparent Scams and Family Emergency Scams
• How to Tell if Something Is a Scam

Last updated: October 3, 2026.

Disclaimer: This article is general legal information about US federal law and federal agency guidance on Medicare and health insurance scams, verified on October 3, 2026. It is not legal advice. For a specific situation, contact 1-800-MEDICARE, the Marketplace Call Center, your Senior Medicare Patrol, the agency named, or a lawyer licensed in your state.

Frequently Asked Questions

Does Medicare ever call you?

Medicare says it will never call you to sell you anything or visit you at your home. Medicare, or someone representing it, calls for personal information only in limited situations, such as returning your call after you joined a plan, reported fraud or left a message.

Do I have to pay for a new Medicare card?

No. The FTC says you never need to pay for a new Medicare card, and Medicare will never call out of the blue to say you will lose coverage.

Is a free genetic test from Medicare a scam?

An unsolicited offer of a free genetic test or cheek swab is a scam pattern HHS-OIG has warned about. It is used to collect your Medicare number for fraudulent billing, and if Medicare denies the claim you could be responsible for the entire cost. Do not accept a kit your own doctor did not order.

What should I do if I gave my Medicare number to a scammer?

Call 1-800-MEDICARE (1-800-633-4227), check your Medicare Summary Notices or your Medicare.gov account for services you never got, and contact your Senior Medicare Patrol at 1-877-808-2468 for help reviewing claims and reporting.

How often do you get a Medicare Summary Notice?

Every 6 months if you had any services or supplies during that period, according to Medicare.gov. With electronic MSNs you get an email for any month with a processed claim.

Can a broker change my health insurance plan without my permission?

Not legitimately. CMS calls this an unauthorized plan switch, and since July 19, 2024 it has blocked agents and brokers from changing a federal Marketplace enrollment unless they are already associated with it. Call the Marketplace Call Center at 1-800-318-2596 if it happens to you.

When is Medicare open enrollment?

October 15 to December 7 every year, to choose a plan for the following year. Marketplace (HealthCare.gov) open enrollment is different: November 1 to January 15.

How do I report Medicare fraud?

Call 1-800-MEDICARE (1-800-633-4227) or the HHS-OIG hotline at 1-800-HHS-TIPS (1-800-447-8477). For Medicare Advantage or drug plan fraud you can also call I-MEDIC at 1-877-772-3379, and your Senior Medicare Patrol at 1-877-808-2468 can help.

Is a medical discount plan the same as health insurance?

No. The FTC says medical discount plans are not insurance and are not a substitute for health insurance, and every company selling health insurance must be licensed by your state insurance commissioner.