As artificial intelligence (AI) becomes more sophisticated, it is transforming not only how we work and communicate, but also how criminals target vulnerable populations
For older adults navigating Medicare enrollment and healthcare decisions, AI is making scams more convincing, more personalized, and harder to detect than ever before.
Why Medicare Enrollment Season Attracts Scammers
Each year, Medicare’s Open Enrollment Period runs from October 15 through December 7, allowing beneficiaries to review and change their Medicare Advantage or prescription drug coverage for the coming year. The combination of complex plan choices, increased marketing activity, and heightened consumer attention could potentially create an ideal environment for fraudsters. Scammers often take advantage of the increased marketing activity and consumer attention surrounding open enrollment to steal personal information, Medicare numbers, and financial data.
Scammers know that many beneficiaries expect to receive calls, emails, mailers, and advertisements about Medicare during this time. This makes fraudulent outreach significantly more believable.
How AI Is Changing the Scam Landscape
Traditional Medicare scams have existed for years, but AI has dramatically increased their sophistication. Criminals can now create realistic voices, highly convincing documents, personalized messages, and even fake websites that closely resemble legitimate government or insurance resources. The result is a new generation of scams that can be difficult for anyone to recognize.
The Federal Trade Commission (FTC) and other agencies have repeatedly warned consumers about Medicare impersonation scams, while financial experts are increasingly highlighting how AI-powered fraud tools enable criminals to scale their attacks and make them more persuasive.
Common AI-Enabled Medicare Scams
Medicare Impersonation Calls
One of the most common scams involves someone claiming to represent Medicare, the Centers for Medicare & Medicaid Services (CMS) or a health insurance provider. The caller may say:
- Your Medicare card needs to be updated.
- Your benefits are about to expire.
- You qualify for new benefits.
- You must verify your information immediately.
The goal is often to obtain a Medicare number, Social Security number, bank account information, or credit card details. Medicare will never call beneficiaries unexpectedly to sell insurance or other products, or to request sensitive personal information. However, Medicare or a plan representative may contact beneficiaries in limited circumstances, such as returning a requested call or contacting an existing plan member.
AI Voice Cloning
AI allows scammers to create natural-sounding conversations, personalize scripts using publicly available information, and generate convincing interactions that sound professional and trustworthy. A scammer could also mimic the voice of a family member, caregiver, or trusted professional to make a Medicare-related request appear credible. These tactics can make fraudulent calls especially difficult to recognize. CMS has warned about the growing sophistication of AI-enabled Medicare “vishing” scams.[1]
Fake Enrollment Websites
Fraudsters increasingly use AI tools to build professional-looking websites that mimic:
- Medicare.gov
- Insurance carrier websites
- Enrollment comparison portals
These sites may offer plan comparisons or advertise extra benefits while collecting personal information that could potentially be used for identity theft or other fraudulent activity.
Phishing Emails and Text Messages
AI enables criminals to create highly personalized emails and text messages that look official. Messages often include Medicare logos, legitimate-sounding language, and urgent requests for action.
They may direct recipients to fraudulent websites or encourage them to provide sensitive information online. Federal consumer agencies advise beneficiaries to be suspicious of unsolicited Medicare-related emails, texts, and links.
AI-Generated Documents
Modern AI tools can produce realistic-looking enrollment forms, benefit notices, premium invoices, and coverage termination letters.
These documents may appear authentic and create a false sense of urgency. Criminals use them to convince consumers that immediate action is needed to avoid losing coverage or benefits.
Why Stolen Medicare Information Matters
Many people underestimate the value of their Medicare number. In the wrong hands, it can be used to:
- Submit fraudulent healthcare claims
- Obtain medical equipment and services
- Commit medical identity theft
- Enroll beneficiaries in plans without consent
- Support larger identity theft schemes
The U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) warns that medical identity theft can result in fraudulent claims and disrupt a beneficiary’s medical care. Protecting your Medicare number and regularly reviewing your claims may help you identify suspicious activity before it leads to additional problems.[2]
Red Flags During Enrollment Season
Beneficiaries should be cautious if they encounter:
- Unsolicited calls claiming to be from Medicare
- Requests for Medicare or Social Security numbers
- Threats that coverage will be canceled
- Pressure to act immediately
- Promises of free money, gift cards, or special benefits
- Emails or texts containing unexpected links
- Requests for banking or credit card information
- Callers asking for payment to issue a Medicare card
These tactics are commonly associated with Medicare impersonation scams and fraudulent enrollment schemes.
How Older Adults Can Protect Themselves
The best defense against Medicare fraud is vigilance.
Experts recommend:
- Never provide personal information during an unsolicited call. Medicare generally does not call beneficiaries unexpectedly to request sensitive data.
- Do not trust caller ID. Scammers can manipulate the name or number displayed on your phone to make a call appear to come from Medicare, an insurance company, or another familiar organization.
- Verify familiar voices independently. If someone claiming to be a family member, caregiver, or trusted professional asks you to share information or contact an insurance agent, hang up and call that person using a number you already know.
- Verify communications independently. If a caller claims to represent Medicare, hang up and call 1-800-MEDICARE directly.
- Use official resources. Visit Medicare.gov or consult your State Health Insurance Assistance Program (SHIP) for enrollment guidance.
- Review Medicare statements regularly. Unexpected charges or services can be an early indication of fraud.
- Remember that a Medicare plan or agent does not need your Medicare number to provide a quote.
- Guard your Medicare number. Share it only with trusted healthcare providers and authorized representatives.
If You Have Already Shared Information
If you have shared your Medicare number or other personal information with a suspicious caller, contact 1-800-MEDICARE and your Medicare plan promptly. Review your Medicare Summary Notices, Explanation of Benefits statements, and Medicare account for claims, services, or medical equipment you did not receive. If you also shared financial information, contact your bank or credit card company immediately.
Reporting Suspected Fraud
If you suspect Medicare fraud or receive a suspicious solicitation:
- Call 1-800-MEDICARE
- Contact your local Senior Medicare Patrol (SMP)
- Report scams to the Federal Trade Commission at ftc.gov
- Contact the HHS Office of Inspector General if healthcare fraud is suspected.
Final Thoughts
Artificial intelligence is making healthcare and Medicare scams increasingly convincing. While technology offers valuable conveniences, it also gives fraudsters new tools to impersonate trusted organizations, create realistic communications, and exploit moments of uncertainty during Medicare enrollment season. By staying informed, verifying unexpected communications, and relying on official resources, older adults can help reduce their risk and make confident healthcare decisions.
Talk to Someone You Trust Before Making Important Decisions
Scammers thrive on urgency and isolation. If you receive an unexpected Medicare-related call, email, text message, or enrollment offer, take a moment to pause before responding. Discuss major healthcare and financial decisions with a trusted family member, caregiver, or professional.
At Modera, we aim to help clients identify risks that can affect their long-term financial well-being and retirement security. While we do not directly provide Medicare enrollment services, we can help clients think through healthcare-related financial considerations, recognize potential warning signs of fraud, and coordinate with other trusted professionals as part of a comprehensive financial plan.
If you have questions about protecting yourself or a loved one from financial scams, contact your Modera advisor.
[1] https://security.cms.gov/posts/why-ai-making-medicare-vishing-scams-more-dangerous
[2] https://oig.hhs.gov/fraud/consumer-alerts/medical-identity-theft/
Sources:
Federal Trade Commission (FTC) Consumer Alerts on Medicare Scams
Medicare Scams: Open Enrollment Red Flags and Card Fraud
This Medicare Open Enrollment season, learn how to protect yourself from scams
Centers for Medicare & Medicaid Services (CMS) Fraud Resources
