The Most Common Health Insurance Scams (and How to Avoid Them)
Health insurance scams are getting bolder, sneakier, and more believable by the day. With so much confusion around deductibles, premiums, ACA rules, and private plans, scammers have found the perfect storm to thrive in. Whether you’re shopping for coverage or already insured, understanding how these scams work is the first step in avoiding disaster.
Let’s break down the most common health insurance scams, how they target people, what signs to look for, and what you should do if you think you’re being scammed.
Common Health Insurance Scams That Cost People Thousands
From identity theft to fake health plans, these scams can drain your bank account, ruin your credit, and leave you without real coverage when you need it most.
1. Fake Health Insurance Plans
One of the biggest scams out there is a completely fake plan. You might get a call or see an ad promoting “low-cost health coverage” with unbelievable perks. These so-called plans often promise full coverage for a fraction of the cost. The catch? They don’t actually exist.
These scammers collect your personal information, charge you a sign-up fee, maybe even take monthly payments, but you don’t have real insurance. You’ll only find out when you try to use it and your provider tells you it’s invalid.
What They Want: Your personal information, Social Security number, bank details, and premium payments.
Warning Signs: No official paperwork, high-pressure sales tactics, vague coverage details, or refusal to send you anything in writing.
2. Medical Discount Cards Masquerading as Health Insurance
Some scammers sell “medical discount plans” as if they’re legitimate health insurance. In reality, they’re just membership programs that offer small discounts on services at certain providers. These are not actual insurance and will not protect you from high medical bills.
This scam is especially common in ads targeting the self-employed and gig workers.
If you're in that category, check out our article Self-Employed? Here’s How to Save Money on Health Insurance in 2025 for real strategies—not scams.
What They Want: Monthly fees for a plan that won’t help when you really need coverage.
Warning Signs: Claims of full coverage for an unusually low price, no mention of ACA compliance, or vague provider networks.
3. Robocalls and Phishing Texts Posing as Government Programs
If you’ve ever received a call or text saying “You qualify for a new government health insurance program” or “Your Medicare card needs to be updated,” you’ve likely been targeted by a phishing scam.
These messages often claim to be from the "national healthcare enrollment center" or "Medicare support" and ask you to provide personal information.
What They Want: To steal your identity and access your Medicare or health insurance benefits.
Warning Signs: Unsolicited messages, vague agency names, requests for personal info over the phone or through a link.
If you're shopping for real, compliant coverage, make sure to read Navigating the Health Insurance Marketplace: Tips for Finding Affordable Coverage so you can spot legit options.
How to Spot a Health Insurance Scam Before You Get Burned
It can be tough to tell the difference between a legit plan and a scam, especially if you’re not fluent in health insurance lingo. If that’s you, bookmark The Health Insurance Language Guide to get up to speed on the terms every savvy shopper should know.
Here’s a quick checklist of red flags that scream scam:
- No official website or documentation.
- They refuse to provide a Summary of Benefits and Coverage.
- They ask for payment over the phone before showing plan details.
- They claim “limited-time offers” or pressure you to sign up fast.
- They don’t mention ACA compliance or preventive services.
- They avoid talking about provider networks, deductibles, or copays.
What to Do if You’ve Been Scammed by a Fake Health Insurance Company
If you think you’ve been scammed, time is everything. Here’s what to do:
- Stop all payments immediately. Contact your bank or credit card company and let them know what happened.
- Report it. File a complaint with your state insurance department, the Federal Trade Commission (FTC), and report phishing attempts to the FCC if you got robocalls or texts.
- Freeze your credit. If you gave away sensitive information like your SSN, protect your identity by freezing your credit with all three credit bureaus.
- Get real coverage. Visit trusted platforms or consult with a licensed insurance advisor to make sure you’re protected going forward.
And if you’ve been paying into one of these fake plans thinking you were covered, read Don’t Get Overcharged: How to Lower Your Medical Bills Like a Pro. It offers tips to keep your out-of-pocket costs from getting out of hand.
The Bottom Line on Health Insurance Fraud Prevention
Health insurance scams are more common than most people realize, and scammers are getting smarter. Whether they’re promising dirt-cheap health plans, posing as government agencies, or selling fake discount cards, the goal is always the same: to get your money or steal your identity.
Being informed is your best defense. Make sure you only work with licensed agents, verify plan details, and take your time before making any decisions.
Want help navigating your options safely and confidently? Set up a free consultation with Insurance Elevated and get started today.
