Avoiding Health Insurance Scams: Red Flags and Safe Enrollment
"Hi, this is the Healthcare Marketplace calling about your insurance benefits..."
If you've received a call like this, you're not alone. And there's a good chance it was a scam.
In 2024, CMS received over 275,000 complaints about fraudulent health insurance activities. The FTC fined one company $145 million for deceptive practices. Over 850 brokers were suspended for unauthorized enrollments and plan switching.
The health insurance space has become a minefield of spam calls, fake websites, unauthorized enrollments, and predatory actors who profit while you lose coverage or get stuck with junk plans.
This guide will help you identify the red flags, protect yourself from fraud, and enroll safely using legitimate channels.
The Scale of the Problem
Let's be clear about what we're dealing with:
275,000+ fraud complaints filed with CMS in 2024 alone
$145 million FTC settlement against Assurance IQ and MediaAlpha for deceptive lead generation
850+ brokers suspended by CMS for misconduct
Common fraudulent activities include: - Enrolling people in plans without their knowledge or consent - Switching people between plans to generate new commissions - Collecting personal information for identity theft - Selling non-ACA-compliant junk plans as "Obamacare" - Charging fees for "enrollment assistance" that should be free
The victims: Often people new to the marketplace, non-English speakers, seniors, and anyone who shares their information with unverified sources.
Red Flag #1: Unsolicited Contact
The warning sign: You receive a phone call, text, or email about health insurance that you didn't request.
Why it's suspicious: The official marketplace (HealthCare.gov) does not cold-call people to sell insurance. Neither does CMS. If someone contacts you claiming to be from "the health care marketplace," they're either lying about who they are or misrepresenting their authority.
What scammers do: - Call with spoofed government-looking numbers - Claim to be from "the Marketplace" or "the Healthcare.gov enrollment center" - Say they're calling about "your benefits" or "your subsidy" - Offer to "help you enroll" or "update your information" - Pressure you to confirm personal details
Safe response: Hang up. If you're concerned about your coverage, go directly to HealthCare.gov or call the official marketplace number: 1-800-318-2596.
Red Flag #2: Pressure Tactics
The warning sign: Someone pushes you to make an immediate decision, sign up right now, or provide personal information without time to think.
Legitimate enrollment is never urgent in this way. Open Enrollment lasts weeks. Special Enrollment Periods last 60 days. There's always time to research and verify.
What scammers say: - "This offer expires today" - "I need to confirm your information right now to save your benefits" - "If you don't enroll in the next hour, you'll lose your subsidy" - "Let me take care of this for you quickly"
Safe response: Any legitimate helper will give you time to verify information and make informed decisions. Pressure is a red flag.
Red Flag #3: Requests for Upfront Payment
The warning sign: Someone asks you to pay them to help you enroll.
The truth: - Enrolling through HealthCare.gov is free - Navigators are free (they're federally funded) - Licensed brokers earn commissions from insurance companies, not from you
What scammers do: - Charge "application fees" - Charge "processing fees" - Charge "expedited enrollment fees" - Request payment via gift cards, wire transfer, or cryptocurrency
Safe response: Never pay anyone to help you enroll in ACA coverage. If they're asking for money, walk away.
Red Flag #4: Requests for Sensitive Information Early
The warning sign: Someone asks for your Social Security number, bank account information, or full financial details before explaining who they are and verifying their legitimacy.
Legitimate enrollment does require personal information — but only through official channels, after you've verified you're working with a legitimate entity.
What scammers do: - Ask for SSN upfront to "check your eligibility" - Request bank account information for "automatic payments" - Ask for ID card numbers or Medicare numbers - Collect detailed personal information through phone surveys
Safe response: Never provide sensitive information to unsolicited callers. Verify the source first. Use HealthCare.gov directly.
Red Flag #5: Promises That Sound Too Good
The warning sign: Someone promises free coverage, no-deductible plans, or guaranteed benefits that don't match what you know about marketplace coverage.
The truth: While ACA subsidies can make plans very affordable (even $0 premium for some people), there are no secret programs with better benefits than what's on HealthCare.gov.
What scammers say: - "I can get you a plan with no deductible for just $50/month" (probably not ACA-compliant) - "There's a special government program most people don't know about" - "You qualify for free insurance" (without asking about your income) - "This plan covers everything with no out-of-pocket costs"
Safe response: If it sounds too good to be true, it is. Verify any claims through official sources.
Red Flag #6: Fake or Misleading Websites
The warning sign: You search for health insurance and land on a site that looks official but isn't HealthCare.gov or your state's marketplace.
The truth: Many lead generation sites are designed to look like official government sites. They collect your information, sell it to multiple brokers, and trigger a flood of spam calls.
How to identify fake sites: - URL doesn't end in .gov (HealthCare.gov, not healthcaremarketplace.com) - Asks for personal information before showing any plans - Has poor grammar or design inconsistencies - Promises to "find you the best rates" without any actual enrollment function - Requires you to submit your phone number before proceeding
Safe response: Type "HealthCare.gov" directly into your browser. Don't click on ads or links from searches. Bookmark the official site.
Red Flag #7: Enrollment You Didn't Authorize
The warning sign: You receive confirmation of a health plan you didn't sign up for, or discover your existing plan was changed without your knowledge.
This is a major problem. Unscrupulous brokers have been caught enrolling people in new plans (or switching existing coverage) to earn new commissions — without the person's knowledge or consent.
Signs of unauthorized enrollment: - You receive an insurance card you didn't request - You get bills for premiums you didn't agree to - You discover your doctors aren't covered because you're on a different plan - You get a 1095-A form for coverage you don't recognize
What to do if this happens: 1. Log into HealthCare.gov and check your application status 2. Call the marketplace (1-800-318-2596) to report unauthorized activity 3. File a complaint with CMS at CMS.gov/Medicare/Fraud 4. Contact your state insurance department 5. If identity theft is suspected, report to IdentityTheft.gov
Red Flag #8: "Limited Health Plans" or Non-ACA Coverage
The warning sign: Someone offers you a "health plan" that's much cheaper than marketplace options but turns out to be a short-term plan, health sharing ministry, or discount card.
These are not ACA-compliant coverage:
Short-term plans: - Can deny coverage for pre-existing conditions - Can exclude essential benefits (maternity, mental health, prescriptions) - Can have lifetime/annual caps - Don't count as minimum essential coverage
Health sharing ministries: - Not insurance — members share costs voluntarily - No legal guarantee of payment - Can exclude pre-existing conditions - Can discriminate based on lifestyle/religion
Discount cards: - Not insurance at all - Just negotiated discounts at certain providers - You're still responsible for full costs
What scammers do: - Sell these products as "ACA alternatives" or "Obamacare replacements" - Don't clearly explain what you're buying - Emphasize low premiums without explaining limited coverage
Safe response: If it's not through HealthCare.gov or your state marketplace, verify exactly what you're buying before enrolling.
How to Enroll Safely
Option 1: Direct Enrollment (Recommended)
Go directly to HealthCare.gov: 1. Type the URL yourself — don't click links 2. Create an account 3. Complete the application 4. Compare plans and enroll 5. Pay your first premium directly to the insurance company
Benefits: - No middleman - No spam calls - No risk of broker fraud - Free to use - 24/7 availability
Option 2: Official Navigator Services
Find a Navigator at LocalHelp.HealthCare.gov: 1. Enter your zip code 2. Find certified assisters in your area 3. Schedule an appointment (in-person, phone, or video) 4. Get free, unbiased help with enrollment
Benefits: - Free (federally funded) - No commissions (unbiased advice) - Trained and certified - Can help with complex situations
How to verify a Navigator: - They're listed on LocalHelp.HealthCare.gov - They never charge fees - They work for community organizations, not insurance companies
Option 3: Verified Licensed Brokers
If you choose to use a broker: 1. Verify their license through your state's insurance department website 2. Ask for their NPN (National Producer Number) 3. Search their NPN at NIPR.com to verify active license 4. Never pay them directly for enrollment help 5. Ensure they show you all available plans, not just ones from companies that pay them higher commissions
Benefits: - Can provide personalized guidance - May offer year-round support - Can help with claims issues
Risks: - Commission incentives may bias recommendations - Unverified brokers may be scammers - Some brokers have committed fraud
What to Do If You've Been Scammed
If you shared personal information:
- Monitor your credit reports — free at AnnualCreditReport.com
- Place a fraud alert on your credit files
- Consider a credit freeze to prevent new accounts being opened
- Report identity theft at IdentityTheft.gov
- Watch for unexpected medical bills that could indicate medical identity theft
If you were enrolled without consent:
- Log into HealthCare.gov to see your current enrollment status
- Call 1-800-318-2596 to report the unauthorized enrollment
- Request to cancel the fraudulent plan
- File a complaint with CMS
- Document everything — dates, names, what was said
- Report to your state insurance department
If you were sold a fake or misleading plan:
- Determine what you actually have — is it ACA-compliant? Insurance at all?
- Check if you're in a Special Enrollment Period — losing coverage or discovering misleading coverage may qualify you
- Enroll in real coverage through HealthCare.gov
- Report the company to your state insurance department and FTC
Protecting Your Information Going Forward
Do:
- Only use official channels (HealthCare.gov, state marketplaces, verified Navigators)
- Create strong, unique passwords for your marketplace account
- Monitor your enrollment status regularly
- Keep records of your actual plan details
- Verify anyone who contacts you before sharing information
Don't:
- Share SSN with unsolicited callers
- Click links in emails about health insurance
- Pay anyone for enrollment help
- Respond to pressure tactics
- Trust caller ID (it can be spoofed)
If You Get Spam Calls:
- Don't engage — hang up immediately
- Block the number
- Report to the FTC at DoNotCall.gov
- Register your number on the Do Not Call Registry (won't stop illegal calls, but makes reporting easier)
Quick Reference: Legitimate vs. Suspicious
| Legitimate | Suspicious |
|---|---|
| You initiate contact | They contact you unsolicited |
| No upfront fees | Asks for payment |
| Takes time to explain options | Pressures immediate decision |
| Uses official URLs (.gov) | Uses unofficial/similar URLs |
| Can verify credentials | Cannot or won't verify |
| Shows all available plans | Only shows certain plans |
| Connects to your HealthCare.gov account | Separate system/process |
| Provides documentation | Verbal promises only |
The Bottom Line
The health insurance marketplace can help you get affordable coverage — but only if you use it safely. The scammers are out there in force, and they're getting more sophisticated.
Protect yourself: - Go directly to HealthCare.gov - Use official Navigators for free help - Verify any broker before sharing information - Never pay for enrollment assistance - If something feels wrong, it probably is
Your health coverage is too important to lose to fraud. Take the extra few minutes to verify you're working with legitimate sources.
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This guide covers health insurance fraud awareness as of 2025. Report suspected fraud to CMS at 1-800-318-2596 or CMS.gov/Medicare/Fraud.
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Disclaimer: This guide is for educational purposes only and does not constitute tax, legal, or insurance advice. Information is current as of 2025 but may change. Always verify details at HealthCare.gov or consult with a licensed professional.