How to Help Members Avoid Medicare Scams This Open Enrollment Season

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3 Minutes Read

By Ali Habashi, Senior Content Manager, Homethrive

Why Open Enrollment Is Prime Season for Scams Every

year on October 15, Medicare's open enrollment window opens the floodgates of marketing aimed at older adults. Mailers promising lower premiums, robocalls dangling free medical equipment offers, and door-to-door pitches all compete for seniors' attention during this narrow window.

Buried among the pushy-but-legal sales tactics is something far more insidious: organized scams that specifically target Medicare beneficiaries. In 2023 alone, reported losses from Medicare-related scams topped $17 million, and because many victims never file a report, the real total is almost certainly higher.

For credit unions, this loss matters. Members who lose money or have their identity compromised during open enrollment often turn to their financial institution first, often after the damage has already been done. Educating members before a scam hits them is one of the most effective ways your credit union can protect both their finances and your institution's fraud exposure.

What Exactly Is a Medicare Scam?

At its core, a Medicare scam involves someone impersonating a Medicare employee, insurance agent, or healthcare provider to extract sensitive information like a Medicare ID number, Social Security number, or banking details.

Once scammers have that information, they can submit fraudulent healthcare claims in the victim's name, opening the door for identity theft, incorrect billing, and disruptions to the member's actual coverage.

Common Scam Tactics Your Members Should Recognize

Scammers rotate through several well-worn playbooks. Here's what to watch for.

The verify your identity scam

A text, email, or phone call claims Medicare needs to confirm the member's identity, often citing an imminent loss of coverage. Both the urgency of the message and the communication itself are tells. Legitimate Medicare representatives don't reach out unprompted demanding personal details. If a member isn't sure whether a call is real, the safest move is to hang up and dial Medicare directly at 1-800-MEDICARE (1-800-633-4227).

The fake plan switch

Someone posing as an insurance agent tells a member their current plan is being cancelled and pressures them to enroll in a replacement. Sometimes that plan that doesn't even exist, or else it has fabricated benefits. Real plan cancellations always come in writing, and Medicare Advantage providers can't legally call a member unprompted unless that member has already called them first.

The free equipment scam

Scammers offer no-cost medical supplies – back braces, orthotics, catheters, genetic testing kits – in exchange for a Medicare ID number. These pitches show up over the phone, at senior centers, health fairs, or even door-to-door. Red flags include equipment showing up that was never ordered, charges for items never received, or claims that an unknown doctor has already approved something the member never discussed with their health care provider.

The data breach alert

After a real Medicare data breach makes headlines, scammers piggyback by contacting beneficiaries and urging them to verify their information to stay protected. In reality, Medicare communicates about data breaches through an official letter from the Centers for Medicare & Medicaid Services. If a beneficiary receives a phone call, text, or email, it’s an indication of a scam.

Red Flags to Share With Members

Encourage members to treat any of the following as a warning sign:

  • Contact arrives by phone, text, email, or in person rather than by official letter

  • The message creates artificial urgency ("act now or lose coverage")

  • The caller asks for a Medicare ID, Social Security number, or bank information

  • Something is offered for free, or a deal sounds too good to be true

  • Pressure to switch plans without the member having reached out first

Practical Prevention Steps to Recommend

  • When in doubt, call Medicare directly using the official number rather than trusting caller ID, which can be spoofed

  • Never share a Medicare ID number unless they placed the call themselves

  • Never give a Social Security number or banking details to an unsolicited caller

  • Review Medicare statements regularly and flag unfamiliar charges with the provider

  • Set up a Medicare.gov account to monitor claims directly

  • Remember that a legitimate-looking phone number doesn't guarantee a legitimate caller

What Happens If a Member Is Already a Victim?

A successful Medicare scam can lead to medical identity theft where a criminal uses the victim's identity to receive medical care, obtain prescriptions or equipment, or file insurance claims. Beyond the immediate financial hit, this can disrupt the member's actual healthcare access and even affect their credit standing, which is where your credit union's fraud and member-service teams may need to step in.

Steps for Members Who've Been Targeted

If a member believes they've fallen victim to a Medicare scam, walk them through these steps:

  1. Review recent statements carefully and confirm every charge, service, and piece of equipment listed

  2. Call 1-800-MEDICARE (1-800-633-4227) to report the compromised number, flag suspicious charges, and request a replacement card if needed

  3. If a Social Security number was also exposed, contact all three credit bureaus – Equifax, Experian, and TransUnion – to place a fraud alert

Members can also escalate the issue to:

The Takeaway for Credit Unions

The scammers that haunt your members during open enrollment every year are a direct threat to their finances. By equipping your older members with the knowledge to spot these scams before they hand over sensitive information, your credit union can help prevent financial losses, reduce downstream fraud claims, and reinforce your role as a trusted resource in members' financial lives.

Connect with Homethrive to learn more.
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Homethrive

Homethrive helps members with the full spectrum of caregiving challenges with a single, integrated platform that proactively recommends next steps and provides hands-on assistance to help your members get ahead of the curve.

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