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Medicare Coverage & Insurance Plan Options: Parts A, B, C, D, and Medigap Explained
By Ari Parker
M-F: 9am-9pm ET and Sa: 9am-9pm ET
By Ari Parker
Most Americans over 65 are enrolled in Medicare. While most people on Medicare are eligible due to age, 16% of Medicare beneficiaries are eligible because they have a disability. Many people know the Medicare name, so they naturally trust calls that claim to be from Medicare.
Unfortunately, some callers take advantage of Medicare's name recognition to promote scams. The scams may encourage you to share information about your Medicare account, identity, and finances. Some scams also or sell seniors goods and services that they don't need. So how can you know if it’s really Medicare? When is Medicare likely to call you? How can you protect yourself against Medicare scam calls?
The short answer to the question is that Medicare representatives are more likely to reach out to you if you have contacted them and need follow-up. A Medicare representative may call back in response to your query. Often, the response might also be by mail, email, text messages, or online.
There are three likely scenarios in which this might happen:
To schedule appointments
To follow up on claims
To inform you how about upcoming changes in your coverage
To follow up on a fraud report you made
To return a call you made to them
Usually, your doctor's office handles communication with Medicare, like getting pre-approval for treatments or figuring out billing codes. You are rarely directly involved in conversations like that.
If you have a Medicare Supplement or Medicare Advantage plan, your Medicare agent is likely the one you will communicate with about changes in coverage.
When Medicare calls policyholders, the representative calls from 1-800-MEDICARE. You can verify the caller's phone number by looking at your caller ID or cell phone history. If they communicate with you by email, their address will be @medicare.gov.
A Medicare representative will have your basic information. They will never ask for:
Your Social Security number
Your Medicare number
Your bank account information
Your credit card number
Of course, if you call in, you may need to verify some information.
If someone calls you and asks for personal information, you should hang up and call Medicare back directly to confirm that it was from them.
Telemarketers play on your concerns about your coverage. Is it in effect? Is it enough? Is there something better available? Are there additional benefits you can claim? The list of potential Medicare scams is long, but here are some of the most common.
The "Medicare Card Replacement" Scam: The caller tells you your Medicare card needs to be replaced as it is outdated or has been compromised.
The "Medicare Advantage" Scam: A caller claiming to be from Medicare claims your plan is being discontinued or you are eligible for an upgrade. They offer a new Medicare Advantage plan that promises better coverage for less.
The "Prescription Drug Coverage" Scam: The caller offers better, cheaper prescription coverage or claims your prescription drug plan is no longer available.
The "Medicare Advantage Plan Fraud" Scam: The caller claims to be from your current Medicare Advantage plan and offers you additional services.
In all these cases, the caller needs your Medicare card number and often payment information, such as your credit card or bank account numbers, to sign you up for whatever they are selling.
Keep in mind that Medicare will not call you about any of these things.
In 2018, Medicare did replace Medicare cards that had enrollees’ Social Security numbers with new cards featuring a new Medicare Beneficiary Identifier (MBI). This change was out of the ordinary, and The Centers for Medicare & Medicaid Services (CMS) advertised the change and then mailed out new cards. Today, unless you misplace your card, you do not need a new Medicare card.
Licensed insurance agents are the ones who help people compare and choose Medicare Supplement (Medigap), prescription drug plans, and Medicare Advantage policies. A licensed agent can be very helpful to older adults because there are several different coverage options. Your Medicare agent will need to collect some personal information, including your health information and Medicare number, so don’t be afraid t o ask for information about who they are and who they work for.
You can only change your Medicare Advantage and Part D (prescription drug) plans at certain times of the year, so beware of anyone who claims you can change your Medicare coverage outside of an eligible enrollment period
Once you sign up with a health plan from companies like Mutual of Omaha, Aetna, or United Healthcare, you will receive notifications from them if your coverage changes.
Medicare.gov is not like Amazon, where everything is for sale. Medicare, a government agency, will not try to sell you anything over the phone or send a salesperson to your home. However, you may get calls directed at Medicare recipients offering food cards, incontinence products, diabetic supplies, medical equipment, other free medical supplies, and many other things you might need.
If you need medical supplies or equipment, calls like this can be very appealing, especially if the telemarketer offers you free or bargain-priced disposable diapers, a knee brace that sounds like it will magically help you, or a power wheelchair. Your first reaction might be, "A deal's a deal." Getting low-cost or even free medical supplies would certainly help your tight budget.
Unfortunately, these calls, along with emails or direct mail, are not authorized by Medicare and are usually scams. Your name, phone number, and address might be on a list compiled from a data breach. You may qualify for a health insurance assistance program, but Medicare scam calls won't give you the help you need and may compromise your personal information.
Buying from scam artists can hurt you in a variety of ways.
They may steal your identity. To qualify for free diabetic strips or a back brace, the scammer may claim they need your Social Security, Medicare number, or credit card information. What the scammer suggests may sound like a reasonable trade-off, so you might be tempted to provide the personal information they ask for.
They may send poor-quality equipment while billing Medicare at an inflated price. As a result, you will be left with junk that won't do the job while overcharging the government.
They may send you items you didn't ask for. For example, you may get a wheelchair or incontinence supplies you don't want. You can't return them, and even though you may not have to pay for them, Medicare still gets billed.
They may use your Medicare number to bill for equipment. AARP sites a case where a Medicare recipient was charged $5,600 for urinary catheters she had no use for. However, this large charge showed up on her Medicare claims statement.
If this happens to you, you usually don't have to pay for the merchandise. You may think you are the unsuspecting party in a victimless crime. However, fraudulent claims like this increase Medicare costs, costing taxpayers over $105 billion per year.
Here's the worst part, though. If you need supplies, a wheelchair, a back or knee brace or other durable medical equipment, you may be unable to get any help. Medicare does pay for certain items, but there is usually a limit. If you have exceeded the limit due to a scam (even if you never received any equipment), you're out of luck and will have to pay out of your own pocket.
Medicare covers some medical items your doctor recommends, but you are responsible for paying 20% of the cost of services (this is your coinsurance). You’ll need to receive your equipment from a Medicare-approved provider. In many cases, you must also rent the equipment until it’s paid for—at which point you own it.What is covered includes "durable medical equipment" (DME) like walkers, canes, CPAP machines, hospital beds, lifts, etc. See our complete list of DME covered by Medicare.
Medicare does not pay for incontinence products or most other supplies that are disposable after one use.
Just over 50% of people on Medicare are enrolled in a Medicare Advantage plan. These plans may include additional coverage for medical equipment, supplies, and over-the-counter products. Furthermore, if you have additional coverage through an employer, union-sponsored retiree health benefits, or Medicaid, you may be able to get additional assistance paying for supplies and equipment.
Regardless of your health insurance coverage, it is unlikely that either Medicare or your Medicare Advantage insurance provider will call you directly to discuss medical supplies and equipment. Be wary of these calls.
Whether you get scammed by someone pretending they are from Medicare or offering a medical service or equipment, hanging up is the best approach to prevent scammers. After you hang up, call the Medicare number or a number you know for your doctor or insurance agent if the caller claimed they were calling on their behalf. Your caller ID information should indicate who called, but clever scammers sometimes use a technique known as spoofing, where calls appear to come from an organization you trust. Rather than hitting the call back button, look up the number from the doctor or government agency,
Telemarketers are skilled at talking people into scams. It's easy to get caught up in their tricks. Here are a few things you can do after the fact if you have been targeted by scammers:
Avoid ordering over the phone. If your doctor recommends medical equipment for you or suggests that you purchase supplies, they will recommend a provider. If you need supplies that you think your Medicare Advantage plan will pay for, check with your insurance company. Once you have contacted a reputable company, you can feel safe about ordering online or over the phone.
Refuse delivery of items you didn't order or that you ordered by mistake. The shipping company will take back unopened items. If you accept delivery, you may be stuck with the items. Return shipping is costly, and there is no guarantee that the sender will accept the return.
Check your Medicare claims notices for suspicious items. Medicare sends out summary notices quarterly, but you can always check your account online for suspicious purchases or unexpected, large charges.
Report Medicare fraud to their special fraud line, 800-633-4227.
The Federal Trade Commission suggests that you report scams directly to Medicare. If you need help reporting the fraud, there are many resources available.
Senior Medicare Patrol at 877-808-2468. Known as SMP, the organization offers information to prevent senior adults from falling prey to Medicare scams. It also helps those who are the victims of fraudulent activity or identity by reporting fraud to the HHS Office of Inspector General. The Senior Medicare Patrol serves the entire country.
The Health and Human Services Office of Inspector General is available at 800-447-8477 or you can file a complaint online. HHS is the government agency that manages the Medicare program
AARP Fraud Watch Network Helpline is available at 877-908-3360
Medicare scam calls are a sad reality. As a senior, you can watch out for the warning signs above to avoid Medicare scams. If you believe you are the victim of a Medicare scam, make sure to report it! A lot of scams go unreported, but this only benefits the scammers, allowing them to continue targeting additional victims.
