Thinking and Meaning

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Medicare, like most health insurance plans, has an annual enrollment. It takes place from October 15 to December 7 each year. When the time draws near to that date, members get phone calls from people who say they work for Medicare. The calls regard upgrading or buying insurance. The bad thing is that insurance can be confusing to the insured. Scammers like to target the elderly who may not understand their benefits.

New Medicare Cards

Medicare used Social Security numbers (SSN) to identify beneficiaries and health insurance claims. In April 2018, CMS began distributing new cards without SSNs. Instead, the new Medicare cards use a unique number which should be protected. Members give the number to medical providers, insurers acting on the member’s behalf, and trusted people in the community, such as State Health Insurance Assistance Program (SHIP) counselors.

It is important to note that members do NOT need to update information, pay a fee, or “activate” their new cards. The agency mailed cards automatically.

Four Parts of Medicare

Members can avoid fraud by understanding Medicare. Understanding the four parts of Medicare is simple unless someone is trying to confuse you. Before talking to anyone about your plan(s), be sure to know what parts you have. Educating yourself in that way will make spotting a scam much easier.

Part A

Part A, coupled with Part B, this is often referred to as “the original Medicare.”

• Inpatient care in a hospital
• Inpatient care in a skilled nursing facility (not custodial or long-term care)
• Hospice care
• Home health care
• Care in a religious non-medical healthcare institution

Note: Part A does not offer full health care coverage.

Part B

Part B is considered a necessary partner to Part A.

• Includes regular doctor visits
• Covers medically necessary services (e.g., wheelchairs or surgeries)
• Preventive health care services, like lab tests and screenings

Part C

Medicare Part C, aka “Medicare Advantage” combines Medicare Part A and Part B. Plans commonly offered:

• Health Maintenance Organizations (HMO plans)
• Preferred Provider Organizations (PPO plans)
• Private Fee-for-Service (PFFS plans)
• Special Needs Plans (SNP plans)

Part D

Part D is Medicare’s Prescription Drug Plan (PDP):

• Helps to cover the cost of prescription drugs
• May help lower prescription drug costs and protect against higher costs in the future

Common Medicare Scams

Most of these scams take place over the telephone, but some do happen through email, U.S. mail and door-to-door visits. Callers steal a person’s identity by making up stories to try to get their name, Social Security number (SSN) or financial information.

Scammers are ruthless. They will say anything to get your information, including your bank account or social security numbers. Many scammers pick seniors who need Medicare to live. Some common scare tactics:

• Caller states that you will lose your coverage unless you join a specific plan.
• Attempts to get you to say “yes” to something.
• You must pay to get a new Medicare card. This isn’t true. Medicare cards, even temporary ones, are free and are sent automatically.
• Attempts to “verify your identity.”
• Someone says you that you must give updated personal information to get a new or updated Medicare card. .
• Fake offers for “free medical supplies.”
• A caller will offer medical equipment and says that “Medicare will cover it.” They ask for your SSN or Medicare Number and/or payment to cover shipping and handling costs for the “free” supplies.
• False claims that you’re eligible for a “refund” or “rebate.”
• Claims you must share information or have your benefits canceled.
• Attempts to get you to enter sensitive data through a fake website link.
• Scammers may send “phishing” emails to get your information

Sensitive Information

Scammers need certain information to steal your identity or to fill out forms on your behalf. They will try to get the following information from you:

• Date of birth.
• Birthplace.
• Mother’s maiden name.
• Social Security number.
• Medicare number
• All or part of your credit card number, including expiration date and security code.
• Your bank account number(s).

Identifying Fake Calls

Scammers aren’t always easy to identify. They get information about the people they call before any a call is made. They may have your full name, mailing address, birthdate, and phone number. The caller may sound professional, sympathetic, and knowledgeable. Others may speak in a foreign or broken accent, which makes them easier to spot. No matter what a person says, never give out personal information. Medicare rarely calls and will never ask for financial information. If you must be contacted, they will send a letter to make an appointment.

If you ever doubt the validity of a phone call, say you’d like to call the person back and ask for their direct number. A real person will respect your desire for privacy and security.

Medicare and the SSA

The elderly is most often targeted by scammers claiming to be from Medicare or the Social Security Administration (SSA). Here are some important things to know about how those agencies work:

Medicare won’t call you, except in limited circumstances. Someone will call if you have called 1-800-MEDICARE and requested a return call. However, if you have called to join a Medicare Advantage Plan (Part C) or Prescription Drug Plan (Part D), you may be asked to give information over the phone. No one should ask for financial information.

• Representatives will never call or come to your home to sell products or services.
• SSA representatives may call Medicare beneficiaries if they need more information to process applications for Social Security benefits or enrollment in certain plans, but, again, this is rare.
• The SSA sends letters to set up a telephone interview.
• Medicare cards do not expire.
• Contact the SSA directly to get a replacement if your card is lost or destroyed. If you think someone else is using your Medicare card, then call Medicare

Have You Been a Target?

If you suspect a scam or receive a call by someone stating to be a representative, use an iPhone app to search by phone number. Hang up immediately if the number is blocked, restricted or unavailable. People should report fraud immediately to StopMedicareFraud.gov, or call the agency directly at 1-800-633-4227. If you have provided personal information to a scam caller or think you might be a victim of identity theft, report it to the Federal Trade Commission (FTC) at IdentityTheft.gov or by calling the ID Theft Hotline at 1-877-438-4338.