In a recent article, “The High Cost of Flood Insurance Fraud” we defined fraud in relation to insurance and listed several tips for avoiding scams. Today, we are continuing our fraud series as we discuss scams to beware of during open enrollment season.
What do we mean by open enrollment?
Open enrollment is a period of time in which participants can sign up for insurance plans, change their existing coverage, or cancel their plan altogether. Open enrollment typically happens during the fourth quarter of the year with coverage adjustments beginning in the upcoming calendar year.
What is the point of open enrollment?
This set aside time allows for change and reevaluation of important coverage options.
Insurers can evaluate the cost associated with the prior year's healthcare and determine if there's any need for adaptation. As well as, examine the quality of care received compared to their specific medical needs. For example, is your doctor in network? Is your recently prescribed medication covered by your existing plan?
What happens if you do nothing during open enrollment?
If you choose not to cancel or make any adjustments to your insurance plan it will, in the majority of cases, automatically renew as is. At that point, you are committing to the plan for another year unless a qualifying event allows you to change your insurance conditions.
What is a qualifying event?
Qualifying events include losing the job that provides the policy, death, an addition to the family, marriage, and divorce. Other considerations include moving, a change in eligibility, and a grown child no longer qualifying under their guardian's policy.
What is open enrollment fraud?
Unfortunately, scammers recognize this period of additions and adjustments as a chance for identity theft or an opportunity for a payout. If you have recently wondered, “Why am I getting so many phone calls about health insurance?” you aren't alone. Scammers have begun contacting individuals to impersonate insurance brokers, companies, or a health insurance marketplace call in hopes of gaining access to your personal information.
Insurance companies will never call you to discuss your health insurance plan unless you first request contact. You must initiate contact if you wish to discuss options. If you receive an unsolicited call regarding open enrollment, do not provide any personal information. Such as:
- Social Security Number
- Employer Information
- Banking Information
- Medicare ID Number
Always safe guard your government-issued numbers. Other red flags to be aware of during open enrollment season:
- Gifts- Decline promotional gifts in exchange for personal information or coverage. It is illegal for an insurance agent or broker to bribe citizens for coverage.
- Be wary of money and personal information requests from strange or new representatives.
- Use verified, official sites when enrolling online. If you are unsure of the website, contact the insurance company via phone. These are the official websites for Medicare.gov and Healthcare.gov for marketplace health plans.
- Impersonation- Scammers are sophisticated criminals. Caller ID may indicate a call is coming from a respected insurer or agency. While in reality, the scammer has cloned the number. Similarly, emails may appear to be official, but contain phishing attacks. (Pro Tip: If you receive a call and aren't sure if it's legitimate, end the call and contact the respective agency using their published number. Medicare: 1-800-MEDICARE (633-4227). Click here to select your state’s Medicaid contact number.)
The Federal Trade Commission, as well as the Better Business Bureau, warn citizens about ongoing scams. Though, fraudulent activity is particularly high this time of year.
Scammers prey on elderly citizens. Much of open enrollment fraud targets Americans over the age of 65 that are enrolled in Medicare. Enrollees in Medicaid services are also heavily targeted by scammers.
What can a scammer do with my Medicare number?
Similar to your social security number, protecting your Medicare identification number is extremely important. If this number gets into the wrong hands a con artist can file false claims to receive reimbursement.
If you suspect a scam or wish to report one, contact the Better Business Bureau for more information and assistance.
What is the largest health insurance program in the US?
Forbes recently published the top health insurance companies in the nation based on enrollment numbers and market share. Below are the top ten largest insurance companies and their contact information.
| Insurance Company | Contact Number | Website |
| Kaiser Permanente | 1-800-777-7904 | Visit Kaiser |
| Elevance Health (Anthem) | 1-800-676-BLUE (2583) | Visit Anthem |
| HCSC (including BCBS plans) | 312-653-6000 | Visit HCSC |
| UnitedHealth Group | 1-866-414-1959 | Visit United Health |
| Centene Corp. | Find contact for your state | Visit Centene Corp. |
| CVS Health Corp. (Aetna) | 1-844-383-6129 | Visit CVS Health Corp. |
| GuideWell (Florida Blue) | 1-800-267-3156 | Visit GuideWell |
| Blue Cross Blue Shield of Michigan | 1-855-237-3501 | Visit BCBS of Michigan |
| Highmark | 1-800-241-5704 | Visit Highmark |
| Blue Cross of North Carolina | 1-888-206-4697 | Visit BCBS of North Carolina |
The Centers for Medicare & Medicaid Services provides coverage to over 135 million Americas, based on 2021 enrollment numbers.
| Medicaid | Find State Medicaid Number Here | Visit Healthcare.gov |
| Medicare | 1-800-MEDICARE (633-4227) | Visit Medicare |
| Children’s Health Insurance Program (CHIP) | 1-800-318-2596 | Visit Healthcare.gov |
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