How to Prevent Medigap Fraud

Don’t be the victim of fraud. Know the signs and know your rights.

It is absolutely prohibited by law for anyone to attempt to commit the following:

  • Coerce you into purchase of a Medigap policy.
  • Deceive you about the plan.
  • Distort the facts to compel you to switch from company to company or policy to policy.
  • Except in certain specific situations, offer to sell a Medigap policy to you if they know you already have Medicaid.
  • Unless your coverage under the Medicare Advantage Plan (like an HMO, PPO, or Private Fee-for-Service Plan) will end before the effective date of the Medigap policy, selling a Medigap policy to a known recipient of a Medicare Advantage Plan.
  • Profess that Medigap policies are part of the Medicare Program.
  • Pretend that Medigap policies are part of any other Federal program. (Medigap is private health insurance.)
  • Allege that a Medicare Advantage Plan is a Medigap policy.
  • Offer to extend a Medigap policy that is legally prohibited in your state. (Educate yourself. Inquire with your State Insurance Department to ensure the Medigap policy you are being offered can be sold in your state.)
  • Desecrate or misapply the names, symbols, acronyms or letters of U.S. Department of Health & Human Services (HHS), Social Security Administration (SSA), Centers for Medicare & Medicaid Services (CMS), or any of their various programs like Medicare. (For example, it would be illegal to claim that the Medigap policy had been recommended by the government.)
  • Declare themselves a Medicare representative. If they work for a Medigap insurance company, they do not work for Medicare.
  • Persist in trying to market a Medicare Advantage Plan to you once you’ve made it clear you choose to stay in Original Medicare and buy a Medigap policy.

NOTE: A Medicare Advantage Plan isn’t the same as Original Medicare.

Know your rights. Enrolling in a Medicare Advantage Plan automatically dis-enrolls you from Original Medicare. You then cannot use a Medigap policy.

If you believe that someone has broken a federal law in connection with Medigap or Medicare, contact the Inspector General’s hot-line at 1-800-HHS-TIPS (1-800-447-8477). TTY users should call 1-800-377-4950.

For all other insurance-related issues, contact your State Insurance Department.