Open Enrollment Scams: Fake Health Insurance Offers to Watch for This Fall

Every fall, millions of Americans face a ticking clock. Open enrollment, the annual window to change, renew, or sign up for health insurance, runs from November 1 through January 15 on the federal Health Insurance Marketplace, with most employer plans wrapping up even earlier, typically in October or November. It's a high-stakes, high-urgency season.

And scammers know it.

They flood phones, inboxes, and social media feeds with fake offers, impersonation calls, and fraudulent plans built to steal your money or your identity, or both. Health care fraud costs Americans tens of billions of dollars every year, with some estimates running as high as $300 billion, according to the National Health Care Anti-Fraud Association, and the problem is only getting worse. In 2024 alone, the Centers for Medicare & Medicaid Services (CMS) received more than 275,000 complaints about unauthorized ACA enrollments and plan-switching, according to KFF Health News.

This fall, before you click, call back, or hand over a single piece of personal information, here's what you need to know.

Why open enrollment season is a scammer's playground

The conditions during open enrollment are almost perfectly engineered for fraud. You're:

• Under time pressure to make decisions before deadlines
• Bombarded with legitimate emails, ads, and mailers about benefits
• Anxious about coverage gaps, costs, and changing plan options
• Sharing sensitive information like your Social Security number and income details

Scammers layer fake offers right into this noise. Because you're already expecting outreach from insurance companies and HR departments, it's much easier to be deceived. Even people who get insurance through their employer aren't safe. Criminals send fake HR emails and create look-alike benefits portals to trick workers into handing over their login credentials or banking details.

6 common open enrollment scams to watch for

1. Fake Healthcare.gov websites

Fraudsters build sophisticated copycat sites that look nearly identical to Healthcare.gov or your state's insurance marketplace, same color scheme, same seals, same layout. The URLs are the telltale giveaway: look for variations like healthcare-gov.net, aca-marketplace.com, or anything other than the official Healthcare.gov.

Once you enter your information, they've got what they need: your name, date of birth, Social Security number, and income, everything required to steal your identity or fraudulently enroll you in plans to pocket subsidy money.

What to do: Always type Healthcare.gov directly into your browser. Never click a link from an email, text, or social media ad to reach the Marketplace.

2. Unauthorized enrollment and plan-switching

This scam is alarmingly widespread. Rogue brokers and agents, sometimes operating in massive networks, enroll you in an ACA plan without your knowledge or consent, or switch you from your current plan to a different one, often to collect fraudulent commissions or subsidy payments.

Florida resident Keith Jones experienced this firsthand. According to KFF Health News, his ACA plan was changed multiple times without his permission. When he finally called the federal Healthcare.gov call center to sort it out, agents on the call witnessed someone actively opening a new policy in his name in real time.

By October 2024, CMS had suspended approximately 850 insurance brokers over involvement in unauthorized enrollments. A December 2025 Government Accountability Office (GAO) report described the problem as persistent and systemic, warning that years of similar alerts had not produced adequate protections for consumers.

What to do: Log into your Healthcare.gov or state marketplace account regularly, especially during and after open enrollment, to verify that your current plan hasn't been changed.

3. Fake "discount" and "limited benefit" plans sold as real insurance

One of the most damaging scams involves plans that sound like comprehensive health insurance but legally aren't. These "discount medical plans" or "limited benefit plans" may charge monthly fees of $30 to $100 and promise sweeping coverage, but when you actually need care, you'll find the plan covers next to nothing.

The FTC has taken action against operators like "Simple Health Plans," which sold sham health insurance to thousands of consumers who thought they had real coverage. These plans often come with phrases buried in the fine print like "This is not insurance", but by the time most people notice, they've already paid premiums for months.

Red flags:

• Very low monthly fees
• Claims of "no deductible" and "no copays"
• Promises of 50 to 80% discounts on all medical services
• No mention of a provider network

What to do: Ask specifically whether what's being offered is a comprehensive health insurance plan or a discount/limited benefit plan. Get the Summary of Benefits and Coverage (SBC) in writing before you pay anything.

4. Government impersonation calls and texts

You receive an urgent call: "This is the Health Insurance Marketplace calling. Your plan will be cancelled in 24 hours unless you verify your information." Or a text: "You qualify for $0 premium health insurance, click here now."

These impersonation attempts are meant to create panic and rush you into handing over personal details or payment. Common scripts include claims like "The government selected you for a special benefit" or "Your coverage will lapse if you don't act today."

The reality: Healthcare.gov does not make unsolicited calls. Medicare will never call you unless you called them first and left a callback request.

What to do: Hang up. If you're worried the call might be legitimate, look up the official phone number on Healthcare.gov or your insurance card and call directly.

5. AI voice cloning and deepfake scams

A newer threat emerging in 2025: Scammers using AI to clone the voices of insurance company representatives, or even family members, to make fraudulent calls sound completely convincing. They record legitimate agents from public videos or voicemails, generate a convincing voice clone, and call claiming there's an urgent issue with your policy that requires immediate payment or personal verification.

This technology has lowered the barrier for highly personalized fraud significantly.

What to do: If a call feels urgent and you're being pressured, hang up and call the company directly using the number on your insurance card, regardless of how convincing the caller sounds.

6. Door-to-door insurance scammers

The most brazen open enrollment fraudsters come directly to your home. One Texas resident reported to the Better Business Bureau that a man arrived claiming to be "from the state" and offering to sign them up for "additional insurance coverage." He carried a notebook with laminated pages he claimed were credentials.

Legitimate health insurance companies do not conduct door-to-door sales.

What to do: Don't engage. Close the door, and if the person is persistent, contact local law enforcement.

Red flags that should immediately raise an alarm

Regardless of what type of scam you're facing, these warning signs apply universally:

Red flagWhat it meansUrgent deadline pressure ("act now or lose coverage")Scare tactic. Real insurers give 30+ days notice before cancellationPayment by gift card, wire transfer, or cryptocurrencyNo legitimate insurer accepts theseUpfront fees just to get a quoteGetting a quote should always be freeRequest for SSN before showing any plan detailsInformation harvesting for identity theftRefuses to provide agent license numberLikely unlicensed and operating illegally"Guaranteed acceptance" with no underwriting questionsNot how real insurance worksPlan "covers everything" with no limitations mentionedAll legitimate insurance has limits and cost-sharing

How to verify before you enroll

A few simple steps can save you from a costly mistake:

1. Verify your agent's license. Every insurance agent must be licensed in your state. Check at NIPR.com (National Insurance Producer Registry) using their name or license number.
2. Confirm the insurer is authorized in your state. Visit your state insurance department's website or search through the NAIC Consumer Information Source.
3. Only use official enrollment channels. Enroll through Healthcare.gov or your state's official marketplace, or directly through your employer's verified benefits portal.
4. Get everything in writing. Before paying a cent, request a written quote with all costs itemized, the Summary of Benefits and Coverage (SBC), and the agent's license number.
5. Don't respond to unsolicited contact. Whether it's a call, email, text, or knock at the door, initiate contact yourself through verified channels.

What to do if you've already been scammed

If you suspect you've fallen victim to a health insurance scam, act quickly.

In the first 24 hours:

• Contact your bank or credit card company to dispute charges and request new cards.
• Change passwords for any accounts that may have been compromised.
• Place a fraud alert with the major credit bureaus (Equifax, Experian, TransUnion).

Within the first week:

• Report to the FTC at ReportFraud.ftc.gov
• File a complaint with CMS (if it's ACA-related) at 1-800-318-2596
• Report to your state insurance department, they can investigate unlicensed agents
• Contact the FBI's Internet Crime Complaint Center (IC3) at IC3.gov for online fraud

If your Social Security number was exposed, consider placing a credit freeze with all three bureaus to prevent new accounts from being opened in your name.

The bottom line

Open enrollment scams work because they borrow the same urgency real insurers create with real deadlines. That overlap is exactly what fraudsters count on.

The fix isn't complicated: verify independently before you act. Checking an agent's license, confirming a plan on your state's approved insurer list, or calling back on a number you looked up yourself takes minutes and closes off nearly every scam on this list.

If you get one thing right this open enrollment season, make it this: nobody legitimate needs an answer from you in the next ten minutes.

Get a free security scan with Guardio today and stay protected from phishing and scam calls.

Conclusion

Open enrollment is one of the most important financial decisions you make each year. Scammers know this. Take your time. Verify before you trust. Use official channels. And remember: no real health insurance plan will ever require you to act right now or risk losing everything. Your health coverage is too important to rush, and too valuable to hand to a fraudster.