With the end of the year comes “open enrollment,” when we sign up for health insurance plans. Pair urgent deadlines with a busy holiday season and insurance premiums that have to get paid, and you’ve got a recipe for chaos that con artists love to capitalize upon. Don’t fall for scammers posing as insurance agents and companies. Instead, always verify before you fork over a penny or share any personal information.
Each fall, millions of people seek to change or renew their health, dental or vision insurance coverage during what’s called “open enrollment.” Lured by such numbers, scammers see the period as open season.
Posing as health insurance agents and agencies, hopeful impostors urgently call, email, and text as they attempt to swipe money or personally identifiable information (PII) from would-be enrollees.
The boldest of the lot might even knock on your door. One Texas resident told the Better Business Bureau (BBB) that a scammer came to their home pretending to be from the state.
“Some guy came to my house saying he was from the state, and he wanted to sign me up for additional insurance coverage. I told him I had Marketplace insurance, and he kept insisting that he wasn’t tied to that,” said the victim. “He said he was there from the state to offer additional insurance coverage. He had a notebook with laminated pages with what he said were his credentials... I finally went back in my house and closed the door after he stood there insisting the State of Texas sent him to get me signed up.”
To learn how to shut the proverbial door on any scammers that may come your way this open enrollment, keep reading.
Enrollment periods explained
To prevent people from waiting until they’re sick or injured to buy insurance, the industry limits when most people can sign up. There are two main windows: special enrollment periods and open enrollment.
Special enrollment periods happen when someone experiences what’s called a “qualifying life event” (things like losing coverage due to a divorce, moving to a new ZIP code, or having a baby). You may also qualify if you’re signing up for Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP). For the full list of qualifying events, visit HealthCare.gov.
Open enrollment is the once-a-year window when anyone can change or update their health insurance plan. Most people get their health insurance through their employer, and workplace open enrollment typically runs from early October through early December, with new coverage starting January 1 of the upcoming year.
If you buy coverage on your own through the federal government’s Health Insurance Marketplace®, open enrollment runs from November 1 through January 15. Depending on when you enroll and pay your premium, your plan will start January 1 or February 1.
Because dates can vary, always confirm your open enrollment window directly with your employer, insurance company, or government program.
Who’s targeted by open enrollment scams?
Scammers target anyone reviewing or changing their health coverage—not just people buying plans through the federal Marketplace. That means individuals, retirees, and families shopping for private coverage are all at risk.
But even people who get insurance through work can be targeted. During open enrollment, criminals know employees are expecting emails and messages about benefits, so they take advantage of the timing. They might send fake HR emails, impersonate benefits providers, or create look-alike portals that ask workers to “log in” or “confirm” their details. Once someone clicks, scammers can steal personal information like Social Security numbers or banking details or trick them into paying fake premiums.
In short: if you’re reviewing your benefits, whether through work or on your own, you’re on a scammer’s radar.
Warning signs of a scam insurance offer, agent, or plan
One of the Federal Trade Commission’s (FTC) main directives is to protect consumers from deceptive and unfair business practices. Besides investigating shady business dealings and suing scammers, the FTC also educates the public on what to avoid.
Whether you’re buying insurance on your own or enrolling through your workplace, scammers may try to take advantage of the busy open enrollment season. When it comes to steering clear of con artists masquerading as legitimate health insurance brokers, agents, and companies, the agency warns of the following common red flags:
Unexpected requests for money or personal information: “No one from the government will ask you to verify your Social Security, bank account, or credit card number,” write the pros at the FTC, “and they won’t ask you to wire money or pay by gift card or cryptocurrency.” A legitimate insurance provider—or your HR department—will never call, email, or text asking for sensitive details like your Social Security number, bank account, or credit card information.
Messages that look like they’re from your employer or benefits provider: Scammers often send emails or texts that appear to come from HR or an insurance carrier, asking you to “log in” to confirm your coverage or update your information. Always access your benefits portal through a known, trusted link. Never through a message you weren’t expecting.
Pressure to buy “supplemental” or “discount” health plans: Some fraudsters pitch fake add-on coverage that sounds like a great deal but offers no real benefits (the Texas whistleblower mentioned above was pitched one of these bogus bonus insurance sales pitches). If you’re enrolling through work, verify any additional plans with your HR or benefits team before signing up.
Demands for payment just to get a quote or renew coverage: “Never enter personal financial information like your Social Security, bank account, or credit card number to get a quote for health insurance,” warn the experts at the FTC. Getting an insurance quote or renewing your existing plan should never cost money. Be skeptical of anyone asking for payment upfront.
Offers to help you navigate HealthCare.gov for a fee: The real pros at HealthCare.gov (the online hub for the Marketplace) assist consumers as they shop for the right health insurance plan at no cost. Called “navigators” or “assisters,” these trained and certified employees help you navigate your options and the enrollment process itself. If someone claims they can “speed up” the process or get you a better deal for a price, it’s a scam.
How to verify legitimate health insurance agents and plans
Fortunately, verifying an honest-to-goodness health insurance agent and an authentic health insurance company is relatively easy. Follow these tips to ensure you connect with legitimate representatives and entities:
Don’t answer calls, texts, or emails from numbers and addresses you don’t recognize. Also, don’t answer or reply to unexpected communication from health insurance companies, even if the source appears to be one you recognize. Instead, go to the company’s website and use the “contact us” numbers, addresses, and contact forms to connect with a representative. Scammers use tech—called “spoofing”—to make themselves appear legitimate on caller ID. The best way to foil a spoof is to contact the business yourself instead of clicking on the number that contacted you.
Work with insurance agents licensed through your state insurance commission. Find these agents on the National Association of Insurance Commissioners (NAIC) website. Choose your state, then visit its individual commission website. Fill out your state’s online form to be matched with licensed local agents. Can’t find the supposed agent? They might be a ghost broker (a fake).
Find a local pro on HealthCare.gov through the button that reads “Find local help.” Use it to choose between a trained and certified assister and an agent-broker. (Assisters are paid via funds and grants from state and federal governments. Agent-brokers earn commissions from the insurance companies they represent.) Both are required to give unbiased direction.
Choose a health insurance company that you access via HealthCare.gov. The site lists providers in your state that are part of the Marketplace network and those that operate privately outside of it. Click here for in-network Marketplace options and on “Plan Finder” for a directory of private providers. (For more great safety tips from the Marketplace, visit their fraud and scam page.)
Search online for the name of a potential agent, insurance agency, or health insurance provider along with words like “scam.” Visit the BBB Scam Tracker and search for those names there, too.
What to do if you fall for a health insurance scam
When sailors “batten down the hatches” before a storm hits, they close and secure their boat’s trapdoors (hatches) to protect themselves and whatever lies below deck. Similarly, if you’ve fallen for a health insurance scam or suspect you may have, it’s time to batten down the hatches that lead to your financial accounts and expose your information.
If you're an Allstate Identity Protection member, you can call us anytime and we'll guide you on how to protect your information moving forward. But even if you’re tackling this solo, you’re not without tools. Start here to lock down your information and limit any further exposure.
First, place a credit freeze on your name at the three national credit reporting bureaus (Click here for links to do just that). Next, lock your credit and debit cards. Many companies let customers toggle this setting in their account profiles. Doing it yourself through the company’s app or websites can be the fastest way to close out con artists immediately.
After that, contact your financial institutions—banks, credit card companies, etc.—and alert them that your account information has been compromised. Follow the steps they advise to close accounts, dispute activity, and restore your financial functionality as needed. Change your logins, passwords, and PINs. Enable multifactor authentication security wherever possible.
Scammers may have stirred the waters, but with swift action and the right tools, you can regain control and protect what matters most.
