Category: Medicare Advantage

Do I Need To Do Anything To Enroll in Medicare?

Do I Need To Do Anything To Enroll in Medicare?

This is a question I get quite frequently at my offices in Sidney and Vandalia, Ohio. When it comes to Medicare, soon-to-be retirees know that they’ve been paying for it since they started working through Social Security. However, they often don’t know how they collect the benefit they’ve worked so hard to earn.


Does it just happen automatically? Or do soon-to-be retirees like you need to do something?


Well, that depends on one thing…


Are You Already Receiving Your Social Security Benefit?

If you decided to claim your Social Security benefit before 65, then you don’t have to sign up. Your Medicare card will arrive in the mail around your 65th birthday and you will be automatically signed up for Medicare Parts A and B.


If Not, Make Sure You Sign Up!

But if you are not receiving your Social Security benefit, you need to sign up during your open enrollment period, the seven-month period surrounding your 65th birthday. You will be doing yourself a big favor by signing up on time because there are many late enrollment fees. For example, the Part B penalty is 10% for every year you are late. Unfortunately, this penalty will continue for the rest of your life.


So take the time amidst retirement planning and birthday celebrations to sign up. You can sign up online at or you can call or stop by your local Social Security office. If you live near Sidney, that office is in Piqua, 227 Looney Rd.  If you live somewhere else in Ohio, find your closest location here:  Ohio Social Security office locations.


Everyone’s Got a Lot More to Consider!

But whether or not you have to sign up for Medicare, you are far from done. It is a big misconception (see our blog on this here) to think that original Medicare alone is enough to cover all your health care expenses. There are two things you should do. Firstly, it is almost always a good idea to pick up a stand-alone prescription drug plan through Part D of Medicare. Otherwise, you will have no coverage for your medications. In addition, I also recommend finding some way to supplement Medicare with additional insurance. You can get a Medicare Supplement plan, or—for those who are more cost-conscious—a low to no cost Advantage plan.


As you can see, even though you may not have to do anything to sign up for Medicare, signing up is just the first step before you have your health insurance in order. I recommend seeing an advisor to help guide you through this complex process.


Need help navigating Medicare? Want personal help to find a plan that is right for your needs and pocketbook? Call Seniormark at 937-492-8800 for a free consultation!


Half-Truths And Medicare Advantage Commercials

Half-Truths And Medicare Advantage Commercials

Weekly, we receive phone calls from people asking about something they saw on their tv and wondering if their insurance covers whatever they are seeing advertised.  This is more prevalant in the fall of each year, when Medicare Advantage companies ramp up their advertising during annual enrollment.  As an office, we offer both Medicare Supplements and Medicare Advantage plans to our clients.  We try to help people figure out what is best for their situation, budget, and lifestyle.  Our end goal is to help people avoid costly Medicare mistakes.  Sometimes, what is portrayed on tv is only half of the story, as you will see below.  This is an article recently published online at Forbes magazine, but echoes our thoughts so we wanted to share.  Source:


If you watched any television in the last several months, you probably saw a slew of commercials for Medicare Advantage plans. One that pops up frequently features a former professional football player who once did a commercial wearing pantyhose. His commercials must be working so well that another former NFL star has also started promoting Advantage plans.

All the commercials, no matter the narrator, talk about the Medicare benefits you deserve, that you should be getting. They list those benefits in a very big and bold font, and encourage you to call the free number and sign up today.

According to Federal law, whatever we see or hear in an advertisement must be truthful and not misleading. I spent some time the last few days closely watching several different commercials. Everything that was said about the cost and benefits was true, to the extent that it was said. But there was much left unsaid and that’s the important information you need to make a smart decision.

First, the benefits

Get the benefits you deserve, including rides to medical appointments, private home aides, nurse and doctor visits by telephone.

Medicare describes these as benefits for daily maintenance and doesn’t cover them. However, because of policy changes, Medicare Advantage plans can now provide them. The plan, not Medicare, must cover the costs. This is a new program and not that many plans offer these benefits.

Based on my preliminary plan research, here are some important points not mentioned in the commercials:

  • These benefits appear to be more common in health maintenance organization (HMO) plans. Except for an emergency, the benefits are only available through a network of selected providers, which can limit the individual’s choice.
  • The plan likely will require prior approval or authorization. Before receiving care, the plan must review and approve the physician’s order.
  • There are limits on these benefits. For example, two meals a day for five days after hospitalization with a limit of four hospitalizations, and a private home aide four hours a day for no more than 31 days in a year.
  • And, most important, the plans we researched require members to select only one benefit per calendar year.

In some of the commercials, there were two more benefits that require clarification.

Free preventive screenings

Medicare covers a long list of preventive and screening services. You don’t need to enroll in one of these plans to get preventive services.

A 75% discount on prescription medications in the Coverage Gap

You see this and think, “Wow! A big discount on drugs! Where do I sign?” However, as with preventive services, this benefit is not unique to Medicare Advantage plans.

The Coverage Gap is more commonly known as the donut hole. In 2020, the donut hole closed. Beneficiaries are responsible for 25% of the cost of medications in this payment stage. Or, in other words, they get a 75% discount. Anyone with Part D prescription drug coverage will qualify automatically for this discount when their total drug costs hit $4,080. This benefit comes with the plans in the commercials, some other Advantage plan with drug coverage, or a stand-alone Part D drug plan.

Second, the costs

All these benefits may be available at no additional cost to you.

The commercials focus on zero-premium plans and benefits available for no added cost. However, at the moment the narrator says this, a line of small type appears on the bottom of the screen. It’s there for only four seconds, while the list of benefits continues. The small type reads, “Plan premiums, copayments, and coinsurance can apply.”

Not all Medicare Advantage plans are zero-premium. And for those that are, it’s important to know that zero-premium does not mean zero costs. There are out-of-pocket costs for most services. Plan members will pay their share of costs until they reach the plan’s out-of-pocket maximum limit. That’s how much a person could write in checks when something happens, like a cancer diagnosis or a major car crash. In 2019, the average limit was $5,059.

Third, the call

The narrators talk about the help you will get when you call the toll-free number. But, once again, the small print is revealing.

Dial the number and you’ll be transferred to a licensed insurance agent. One commercial noted that the agent may or may not offer Medicare Advantage plans. Another said the person you talk with may not offer plans in your area.

A question

The facts, as presented, are true but then the question becomes, “Are these commercials misleading?” According to the Macmillan dictionary, misleading means something that is intended or likely to make someone believe something that is incorrect or not true.

In fall 2019, the American Medical Association (AMA) passed a resolution.

“Whereas, Medicare Advantage plans are heavily marketed to seniors by insurance companies, with less than ideal transparency in advertising; … and

“Whereas, Presentations by insurance company officials to seniors can overemphasize the value of different options and can create confusion; therefore be it

“RESOLVED, That our American Medical Association encourage AARP, insurance companies and other vested parties to develop simplified tools and guidelines for comparing and contrasting Medicare Advantage plans.”

The AMA identified the need for tools to help individuals go beyond the TV commercials and get the information they need to make a smart decision.

The Centers for Medicare and Medicaid Services redid its tool for comparing plans. The Medicare Plan Finder shows the premium in a large font. Then, you can check out the plan’s out-of-pocket costs for medical benefits on the details page. Beyond that, as pointed out in a past post, most of the essential information has disappeared. The Plan Finder no longer has links to networks, a list of preferred pharmacies, and most important, complete information about coverage rules like prior authorization.

The best way to get all the facts is to check the plan’s Evidence of Coverage. This document describes in detail the plan’s benefits, how much you will pay, and how the plan works, including authorization rules, limits, networks, and more. To find it, go to the plan’s website, look for the Evidence of Coverage link. This may take some searching but you’ll get the information you need on available benefits, limits, approval, and more.

Keep in mind that these Medicare Advantage plans are offered by for-profit entities, corporations not unlike your cable provider, department store, or neighborhood used car lot. The purpose of the TV commercials is to get you to act, to call the number on your screen, to make a purchase. First, do your research. Be an informed shopper. Go beyond the commercials to the whole truth. Your Medicare coverage is too important.

If you would like help muddling through all of this confusing information, please give our office a call.  We are happy to help you sort through the complicated Medicare alphabet and choices!  Call our office at 937-492-8800 and schedule a free, no obligation consultation.

Source:  Diane Omdahl for Forbes Magazine

Know Your Rights! (Your Medicare Supplement Guaranteed Issue Rights)

Know Your Rights! (Your Medicare Supplement Guaranteed Issue Rights)

Everyone knows that they have the right to remain silent and the right to an attorney, but few retirees know their rights to a Medicare Supplement policy. For this reason, many people believe that if they missed their Open Enrollment Period and have health problems, they will be unable to get insurance.


This is not so. Thanks to guarantee issue periods, retirees like you have rights. During guaranteed issue periods, insurance companies are obligated to offer you a policy at the normal rate and cover your pre-existing conditions. All of this with no pesky medical questioning whatsoever!


The following circumstances spur a guaranteed issue period. In other words, you have the right to a Medicare Supplement policy if:

  • Your Medicare Advantage Plan is going out of service or you are moving out of the service area.
  • Your employer health insurance is ending.
  • You’ve been enrolled in an Advantage Plan for less than one year and want to switch back to a Medicare Supplement plan.
  • You lose your coverage without fault (i.e. your insurance company goes bankrupt).
  • Your insurance company misled you or doesn’t follow the rules.

(For a more comprehensive chart of potential situations, click here to visit


From the day any one of these events happen to you, you have 63 days of guaranteed issue to get into a new Medicare Supplement Plan.


Do not take this newfound information lightly, and keep any proofs of the previously mentioned events at your disposal such as:

  • Claim denials
  • Letters from employers
  • Official notifications


Insurance companies will ask for these items to prove your right to a policy. Then they will have no choice but to insure you. This is why it is so important to educate yourself on your rights. It allows you to take advantage of what has been made available to you.


If you want to find out more about guaranteed issue rights or need help shopping a Medicare Supplement Plan for your needs, Call Seniormark at 937-492-8800 for a free consultation from licensed experts.

What Is My Full Retirement Age? (And Why Does It Matter to My Social Security Check)

What Is My Full Retirement Age?

(And Why Does It Matter to My Social Security Check?)


Laws, guidelines, tax codes, regulation, health care—pretty much everything involved with the government—is constantly evolving. And the full retirement age is no different.


Life expectancy has been rising. So that means that retirees are drawing on their Social Security for much longer than they used to. Couple this with shockingly high spending for other programs, and you’ve got yourself a little budget problem on your hands. Social Security has to remain solvent somehow!


This is why the full retirement age is creeping up. Ever since Ronald Reagan signed the 1983 Social Security Act amendments, the government has been inching its way to a full retirement age of 67, like peeling off a Band-Aid nice and slow.


But What’s My Full Retirement Age?

Your full retirement age depends on when you were born. The younger you are, the closer your full retirement age will be to 67. But if you’re retiring soon, your full retirement age is likely 66. Check out this chart from to find out for sure:


Why Does it Matter to My Social Security Check?

Your full retirement age is when you qualify for full Social Security benefits (not to be confused with your Medicare eligibility)[LINK TO WARNING: CONFUSING MEDICARE AND SOCIAL SECURITY ELIGIBILITY]. You can apply as early as age 62, but you will receive reduced benefits, only 75% of what you would’ve received had you waited until your full retirement age.


But there’s another side to this coin. You can also delay your benefits, leading to bigger benefits. For every year you delay beyond your full retirement age, you get an extra 8% tacked onto your Social Security check every month.


These options leave a lot up to you, and I wouldn’t take them lightly. Deciding when to start your Social Security takes a lot more than just understanding your full retirement age; it calls for a carefully planned strategy, another step along the way to a successful retirement.


Looking for some strategies to help you get the most out of Social Security? Click here.

3 Reasons to Start Medicare Planning NOW!

3 Reasons to Start Medicare Planning NOW!

Every last one of us is pretty much the same in this respect: we don’t take now for an answer. When the task is daunting, overwhelming, or complex, we always manage to escape doing it now by putting it off for tomorrow. We’re like a gaggle of Houdinis. Just when you think time constraints have us trapped, we magically free ourselves into an enchanted tomorrow land of channel flipping, Internet surfing, and power naps.


But some things are just too important to put off. Even for one more day, one more catnap, one more rerun of I Love Lucy. Medicare planning is one of these things. Not convinced? Here are three reasons why you should start the Medicare planning process now:


Reason #1 Mistakes Happen

Glitches. Mistakes. Goofs. If there is a way something can go wrong, Lord knows it probably will. Just like a customer service call can turn into several hours of God-awful hold music, a small slip-up in the Medicare process can turn a five minute solution into a month long ordeal.


This is because you are just one of the 10,000 people turning 65 everyday. Medicare has a lot to handle; little things can slip through the cracks. Even if you are fortunate enough to not make any mistakes, you still have to plan in advance for theirs.


Reason #2 You’ve Got a Ton of Decisions to Make

Do you need a med sup? Or should you go the Medicare Advantage route? Should you sign up now? Or wait until you are done working? When are the deadlines? What are the penalties? What is a donut hole and how do I navigate it?


Take these questions along with deciding between 24 drug plans, 11 supplement plans and a legion of Medicare Advantage options, and you’ve got yourself a to-do list you can’t leave until the last minute.


Reason #3 Your Hairdresser Is Not a Retirement Advisor

Getting advice from your family or friends over coffee at church or in-between hands of euchre won’t cut it.  And no, your all-knowing hairdresser won’t do either.   Although your loved ones and acquaintances may have your best interests at heart, they simply do not know the ins and outs of Medicare. What was right for them may not be right for you. And what they overheard at the grocery store is (gasp) probably not watertight advice.


This is why seeing an expert is a great (dare I say the only) way to make sure you are on the right track, ensuring you a smooth, penalty-free transition to retirement. But you may find it difficult to schedule an appointment if you wait last minute. We will still help you out, of course, but it will save you a lot of stress to plan an appointment weeks or months ahead.


So—when should you start the Medicare Planning process? If you are within 6 months of turning 65, the answer is…you guessed it…Now!



Maybe not now, right?


Not sure what to do next? Give us a call at 937-492-8800 for a free consultation!

The Part D “Donut Hole” Is Not as Tasty as You Might Think

The Part D “Donut Hole” Is Not as Tasty as You Might Think


Apple is a 605 billion dollar company. Blackberry is a pocket-sized desktop computer. Yes, it’s true. You can now add one more item to your list of foods the 21st century has complicated. You may be used to eating a donut hole with your cup of joe in the morning, but keep in mind that the Part D “donut hole” is not nearly as powdery, chocolately or delicious. In fact, it could be costing you on your prescription drug plan.

To clarify, The Part D donut hole is a gap in your prescription drug coverage. In the donut hole, you continue to pay normal premiums but Part D covers less. This means higher drug costs and less expendable income for you.


There are 5 main things you need to know about this mysterious pseudo-food:


1. The Donut Hole Starts When You Reach $3,820 in Total Prescription Drug Costs.

The key word here is total. $3,820 is not what you pay for drugs. It is not what Part D pays. It is the sum of both. The only cost not included in the $3,820 threshold is your monthly premium.


2. Once You Are In the Donut Hole, You Will Pay 30% For Brand Name Drugs and 37% For Generic Drugs.


3. The Donut Hole Ends When You Reach $5,100 in Out-of-Pocket Prescription Drug Costs

 Again, this tidbit of info has a keyword. In this case, it is “out-of-pocket”. The amount of money Part D pays is irrelevant. The $5,100 figure only includes what you pay for prescription drugs, minus the monthly premium, of course! Once you exceed $5,100 for out-of-pocket costs, you enter into what is known as “catastrophic coverage”. At this point, you only pay 5% of your prescription drug costs.

4. Medication Costs are Rising.

This might seem obvious. But what might not be obvious is the effect it can have on your entry into the donut hole. The higher the cost of drugs, the sooner you pay the higher 30 or 37 percent coinsurance rate. For example, in the Pittsburgh Post Gazette’s article about rising drug costs, they tell the story of retiree Milly Scott. This seasoned Medicare beneficiary was used to her usual copays until the rising costs of drugs put her in the donut hole late in the year, October.  The very next year she entered the donut hole 3 months earlier, in July! Part D coverage gaps paired with higher costs can wreak havoc on your finances, so plan accordingly.

5. The Donut Hole Is Closing



I made sure to save the best news for last. Although the donut hole is not gone yet, it is on its way out the door. Regardless of your opinion of the Affordable Care Act, it is shrinking the coverage gap dramatically. Beneficiaries used to pay the full amount of their drugs in the donut hole, and now they only have to pay 30-37%. The plan is to close the coverage gap completely by 2020!


In light of this news, I suggest breaking out some Krispy Kremes to celebrate!


Have more questions about the donut hole?  Contact our office for a one-on-one appointment and we can tailor an appointment for you!  Call Seniormark at 937-492-8800.


Not Tech-Savvy? Here’s How to Sign Up For Medicare

Not Tech-Savvy? Here’s How to Sign Up For Medicare


You might feel comfortable surfing the net, but that doesn’t mean you are ready to brave the more serious aspects of the online world, like online banking or enrollment in Medicare.


As soon as a website starts asking for personal information like your social security number or place of residence, I can understand your hesitation. You want to talk to real people with real faces, not interfaces or cold, algorithm-driven databases. If this is you, you are at the right place. Here are a couple ways to sign up for Medicare… the old fashioned way!


Call the Regional Social Security Office at 1-800-772-1213


At one time, this was the tech-savvy option, but not anymore. Nowadays, in the world of texting and email, it is almost nostalgic to hear another person’s voice across the line. Of course, you won’t hear the local operator anymore; in fact, the person who picks up won’t even be local. They will be from the regional Social Security Office, which is in Chicago (if you are from Ohio). Just tell them you need help signing up for Medicare, and they should guide you through the process from there.


Visit Your Local Social Security Office

If you would still feel more comfortable sitting down with someone face to face, this option is the way to go for you. However, it’s quite time consuming. If you call and schedule an appointment, there could be a 1-2 month wait before you get in! And if you walk in without an appointment, don’t be surprised if you have to take a number and hang out in the waiting room for a while, 30 minutes or maybe more.


Of course, these two choices are not nearly as fast as signing up online, nor are they the most convenient. But there is something to be said about that personal interaction of a call or a face-to-face meeting. It provides an element of trust that is hard to find on the web.


If you run into any problems, questions, or concerns while signing up for Medicare, give Seniormark a call at 937-492-8800 or just walk right into our Sidney office right next to Culvers. We can guarantee you won’t have to take a number and wait!


Medicare Fraud Causes Patient Suffering and Death

Medicare Fraud Causes Patient Suffering and Death

Medicare fraud is not a victimless crime. It doesn’t just affect the government; it affects you and your family in the form of higher taxes and reduced benefits as the government struggles to keep Medicare from going bankrupt.


But did you know that it has killed people? Did you know that it has also caused much suffering to patients? In the light of these 3 cases that I’ve found, the financial burden of fraud is not nearly as costly as the loss of life and human dignity.


Case #1: Unnecessary Narcotics Prescribed

According to the Atlantic, one case of Medicare fraud involved a Michigan doctor who “prescribed unnecessary narcotics in exchange for patients’ identification information, which was used to generate false billings.” This then caused the patients to become hopelessly addicted to the narcotics. It kept them coming back for more, which kept his scheme well funded until it was busted along with 242 other Medicare fraudsters on June 18, 2015.


Case #2: Fake Doctors Employed

In the AARP’s June 2016 Bulletin, they tell of Dr. Rafael Chikvashvili, a man who employed fake doctors to “examine the X-rays, ultrasounds and cardiac examinations that his company, Alpha Diagnostics, provided to nursing homes throughout the mid-Atlantic.” This gross malpractice cost 2 patients their lives to congestive heart failure. The fake doctors didn’t have the skills or knowledge to interpret these important tests. As a result, they ended up misinterpreting the patients’ X-rays or failing to diagnose the issue. Both of the patients didn’t get the care they needed, and they both ended up dying from their congestive heart failure. Chikvashvili faces life in prison for his actions.


Case #3: Chemotherapy Falsely Administered

In July of 2015, CNN released a report about Dr. Farid Fata, a hematologist who “gave cancer treatment drugs to patients who did not need them — including some who didn’t actually have cancer”. According to the article, these chemotherapy treatments were both painful and life altering. One of the victims lost all but one of his teeth due to the harsh treatments. In AARP’s June 2016 Bulletin, they claimed that he “improperly administered” chemotherapy to over 550 patients! Needless to say, he is now serving 45 years in prison.


Most fraud doesn’t affect the health and well being of patients, only finances. But every once in a while, a malicious case of Medicare fraud causes someone to lose her life or experience intense suffering like those victims who underwent years of unnecessary chemotherapy.


This is why we need to band together against Medicare fraud. The best thing you can do is to educate yourself. You need to be aware of what it is, whom it affects, and how to recognize it, so you can turn the fraudsters in. This saves the government (and yourself money), but beyond this, it could also save lives.


For more information about how to recognize Medicare fraud, click here:  How to Detect Medicare Fraud.


If you feel you have been a victim of Medicare fraud, please contact Medicare at 1-800-MEDICARE.


As always, if you have other questions, please call our office at 937-492-8800.

4 Lightweight Tips to Prevent Medicare Fraud

4 Lightweight Tips to Prevent Medicare Fraud


An ounce of prevention is worth a pound of cure. Very few people use this saying anymore, but the truth of it is still relevant—almost shockingly so. Especially when it comes to Medicare fraud.


No one wants to be a victim. No one wants to deal with some con down in Florida, racking up charges using their Medicare number. And no one wants to feel taken advantage of.


That’s why it’s much better to take the simple steps now. So let’s get started.


  1. Protect your Medicare Number!

First things go first. It’s the oldest tip in the book, but it works. This number is unique to you.  So protecting those 9 digits is doubly important: It’s your identity.


One way to protect your number is to avoid carrying the actual card unless you have to. And—this almost goes without saying—don’t share it with anyone except your doctor, health care provider, and your insurance agent, who will need it to write a policy.


  1. Take a Lesson From Sherlock Holmes.

This sounds like a pound-sized piece of advice, but it’s really not too heavy once you get into the habit. Be like Mr. Holmes and notice the small stuff. Check your Medicare Summary Notice for anything suspicious (i.e. billing to Medicare for care or services you didn’t receive). Check your pills before you leave the pharmacy to make sure everything is correct. Did you get your full prescription?


It pays off to notice things that no one else does. It’s elementary, my dear…umm…Medicare beneficiary?


  1. Strive to Understand for Yourself.

This is another tip that sounds heavier than it really is. So allow to me translate. For all intents and purposes, this means to ask questions. And I mean a lot of questions.


When you don’t understand your bill or your plan or your Medicare options, just ask. Ask your doctor’s office, or ask at your insurance agent’s office.  Shift the weight on the expert to help you understand. If he gives you a boulder-sized answer, give him another boulder-sized question. And don’t let down until you get a manageable answer. This might sound stubborn, but you have a right to know what you want about your health care. It’s the expert’s job to give you an understandable (yet accurate) answer.


Because knowing how Medicare works, your plan works, and why you were taken care of the way you were are excellent starting points for noticing and preventing fraud.


  1. Don’t go to the mousetrap for the free cheese.

Only a mousetrap has free cheese. This is the truth with all the sales and advertising junk pared away.


It’s not that I don’t understand the allure. Someone comes to your door or calls you to offers you something for free. Do you believe it? FREE! All you have to do is give them your Medicare number and then POOF…all your money saving dreams can come true.


But don’t fall for it. Don’t go for the cheese. This is a surefire way to get snapped into the metal jaws of Medicare fraud.


Stopping Medicare Fraud Ounce by Ounce

In closing, Medicare fraud is a crushing problem. The Medicare Fraud Strike Force is constantly hunting down the bad guys, trying to recover as many funds as they can. But it hardly puts a dent in the 60 billion dollar a year problem, according to AARP. This is why the government needs you to take the necessary measures of prevention. It’s a big problem, but I am confident that if enough people decide to get smart and do these small  “ounce-sized” things now, we can prevent another round of crushing Medicare fraud later.


Think you’ve been a victim of fraud? Want to make up to $1000? Then check out this post! 


Still have questions?  Call our office at 937-492-8800.  We can help!

CONSUMER ALERT: Seniors Should Beware of DNA Testing Scam

COLUMBUS – Ahead of World Elder Abuse Awareness Day this Saturday, June 15, the Ohio Department of Insurance and the Ohio Department of Aging are warning Ohioans of a new scam targeting seniors. Ohio consumers should be cautious of genetic testing firms visiting senior communities or making unsolicited phone calls and mailings related to DNA screenings.

“Scam artists are always looking for new ways to steal money or personal information,” said Governor Mike DeWine. “We want people to be careful and to know the signs of a possible scam.”


In the scheme, which has been reported in Ohio and other states, firms reportedly collect consumers’ personal information under the pretense of DNA testing to screen them for cancer, Alzheimer’s, or other life-threatening diseases. Victims are told that Medicare will cover the cost of their testing. However, Medicare provides limited coverage for DNA testing (which is why consumers should consult their health care providers). As part of the scam, consumers often are asked for their Medicare card number and Social Security number.


“We want Ohioans to be aware and cautious as they consider DNA screening services,” said Ohio Department of Insurance Director Jillian Froment. “Consumers should never share their personal information, including Social Security number or Medicare card number, with anyone who reaches out unexpectedly. If you think you may be a victim of fraud or if you suspect potentially fraudulent activity, please contact us.”


“Scammers and shady businesses target older adults to steal money, get personal information, or in this case, improperly access individuals’ insurance benefits,” added Ohio Department of Aging Director Ursel McElroy. “As older adults get wiser to common scams, scammers are doing more to try to win their trust. Guard your Medicare or other insurance card like you would a credit card. To a scammer, it is just as valuable.”


To protect yourself, be alert if anyone conducting DNA cheek swabs requests that you agree to be billed for services in the event Medicare does not pay. These types of “testers” may be committing Medicare fraud because they are attempting to bill Medicare for a procedure that has not been ordered by a health care provider.

What Should Medicare Recipients Know About Genetic Testing?
  • In order for the testing to be covered by Medicare, it must be medically necessary.
  • Consumers should always confirm that their test has been ordered by their doctor, that it’s covered by their plan, and that it’s medically necessary.
  • If you are interested in DNA screening, talk to your doctor and determine if it is right for you.

How Can I Protect Myself from This Type of Scam?

  • If you or a loved one is approached by someone claiming to offer genetic testing, do not give your personal information (like your Medicare or Social Security information) to them.
  • Theft of Medicare card numbers may be used to commit identity theft or fraud.
  • Instead of receiving a DNA screening unsolicited from a firm not affiliated with your health care provider, talk to your doctor first and determine if the test is necessary.
  • Some consumers have reported receiving DNA testing kits in the mail without requesting them. Consumers should not use these kits but should instead talk to their doctor first.

If you suspect wrongdoing or if you believe you have been victimized, call the Ohio Department of Insurance’s Fraud and Enforcement Hotline at 800-686-1527 or the Ohio Senior Health Insurance Information Program at 800-686-1578.

Older Ohioans and their loved ones can learn more about scams and other forms of elder abuse and exploitation, along with ways to prevent and report them, on the Ohio Department of Aging’s website (


Source:  Ohio Department of Insurance