Medicare Open Enrollment and Government Shutdown Fuel Fall Scam Risks

Heightened Scam Risk During Fall Enrollment: Why Insurers Need to Stay Vigilant

With the annual Medicare Open Enrollment Period (October 15–December 7) now underway, insurance professionals face a perfect storm of fraud risk. Add to this the backdrop of the extended federal government shutdown—and you’ve got a scenario that requires heightened attention.

Why this season is especially vulnerable

First, the Open Enrollment window naturally triggers more activity: many beneficiaries review or change plans, details get updated, and beneficiary outreach is amplified. Scammers know this. According to the Federal Trade Commission (FTC), fraudulent schemes frequently use the promise of a “new” Medicare card or insist that recipients must verify personal details now, during the enrollment period. (Consumer Advice)
Second, the ongoing federal government shutdown creates additional strain. While Medicare benefits themselves are funded and continue operating, support services and communications channels are under pressure. The Centers for Medicare & Medicaid Services (CMS) has acknowledged that some administrative functions are delayed or suspended during the shutdown. (Senior65)
This combination means beneficiaries may face delays, confusion, or reduced support—factors that scammers are more than ready to exploit.

What insurers and agents should watch

Here’s a breakdown of what to monitor closely:

• Unsolicited calls or texts claiming to be from Medicare, asking for a “verification” of your card or requesting payment for a replacement. Legitimate Medicare cards are mailed for free; call-in verification is not required. (Consumer Advice)

• Pressure tactics that highlight “limited time” to change plans, “mandatory” actions, or penalties if the enrollee doesn’t act immediately. Scammers lean into urgency. (All Seniors Foundation)

• Beneficiaries receiving confusing or conflicting information about plan-changes or provider networks—particularly as new tools and directories (some of which are still experiencing accuracy issues) come online. (MarketWatch)

• Situations where beneficiaries express frustration with long wait times, unexpected account notices, or lack of clear communications—these gaps create the opening for fraudsters.

Why the shutdown raises the stakes

Even though core Medicare funding remains intact during the shutdown, the operational impact is real. One expert noted:

“Medicare beneficiaries and those aging into Medicare could encounter significant delays and have a hard time getting timely information.” — Anne Montgomery, senior health expert (Investopedia)
In short, when public-facing support services are strained, scammers step in with plausible narratives of "We’re from Medicare and helping you now"—and enrollments go unchecked. From an insurer’s perspective, that means increased odds of a beneficiary getting switched into a plan without full understanding, paying hidden fees, or having personal data compromised.

Why this matters for the insurance industry

As insurers, brokers and agents, your role is not just selling plans—it’s safeguarding trust. When scams thrive, several risks emerge:

• Reputation risk: If beneficiaries become victims, they may associate that failure with the plan, the agent or the carrier.

• Fraud risk: Data theft or unauthorized enrollments can lead to false claims, charge backs, or compliance headaches.

• Service risk: Confusion over provider networks, delayed communications or replacement cards can trigger member dissatisfaction or churn.

Practical actions you can take now

• Reinforce communication to your clients/beneficiaries: remind them that Medicare will not call unexpectedly requesting financial or personal information.

• Educate your front-line staff and agents to recognise and report suspicious outreach or enrollment behaviours.

• Monitor plan-change requests, especially those initiated outside usual channels, for signs of urgency or inconsistent information.

• Audit your beneficiary communication flows: are you clarifying when, how and why you contact members? Are support delays due to shutdown-related staffing issues documented?

• Pay particular attention to new or updated tools—such as provider directories—where verbiage, links or user-experience may be confusing, creating risk of mis-direction or exploitation.

• Document and track any complaints or unusual outreach, so you can spot patterns early and alert your compliance or fraud-prevention teams.

Bullet-point summary for quick reference

• Open Enrollment = heightened scam risk: more outreach, more confusion, more fraud targets

• Shutdown = reduced support capacity, higher operational strain, greater vulnerability

• Fraudsters exploit: “new card,” unsolicited contact, urgency, plan-change pressure

• Insurers’ exposure: reputational, fraud/claims, member dissatisfaction

• Key actions: educate staff + members, monitor enrolment flows, audit communications, track complaints

Final word

For the insurance community, this Fall’s conjunction of Medicare Open Enrollment and the federal government shutdown represents more than just a calendar event—it is a potential inflection point for elevated risk. The good news: by staying proactive, reinforcing communications and monitoring the details, you can turn this elevated risk into an opportunity to strengthen trust, demonstrate value and safeguard your members and your brand.