#United States #Albany #Medicare Fraud #StateWide #Prescription Drug

Scams Involving the 2026 Medicare Prescription Drug Cap

The New York StateWide Senior Action Council (StateWide) has raised the alarm about a new wave of scams targeting seniors related to the upcoming changes in Medicare's prescription drug coverage. As of January 2026, a $2,100 cap will limit out-of-pocket expenses for seniors regarding covered prescriptions. Unfortunately, scammers are leveraging these changes to instill fear and confusion among beneficiaries.

The Background of Medicare Changes

The donut hole, an infamous coverage gap present in Medicare Part D, was eliminated starting in 2025, helping to alleviate some financial burdens for seniors. Under the new policy, once seniors reach the $2,100 cap, their costs for covered prescriptions are eliminated for the remainder of the year. Additionally, a voluntary payment plan allows seniors to distribute their prescription costs throughout the year, rather than facing large upfront fees at pharmacies.

Pushback from Scammers

Maria Alvarez, Executive Director of StateWide, points out that this new Medicaid policy is a prime target for fraudsters. Unsuspecting seniors may receive unsolicited phone calls from scammers posing as Medicare representatives, offering assistance for the new drug coverage while asking for sensitive personal information such as their Medicare number. These callers may falsely claim that to qualify for this new cap, seniors must pay upfront fees or processing costs.

In reality, legitimate Medicare programs will never ask for payment before you can access your benefits, and no additional cards are needed for those enrolled in the Medicare Prescription Payment Plan.

How Seniors Can Protect Themselves

To combat these scams, seniors are urged to be vigilant and take proactive measures. Here are several important tips from StateWide to keep in mind:
1. Stay Alert: Avoid answering unsolicited phone calls claiming to provide services related to Medicare. If the call seems suspicious, hang up immediately.
2. Verify Information: For any questions or concerns regarding Medicare, always contact legitimate sources directly. You can call the New York State Senior Medicare Patrol (SMP) at 800-333-4374 or visit their official site at www.nysenior.org.
3. Don’t Share Personal Info: Never provide personal information over the phone unless you’re certain of the caller’s identity and legitimacy. Protect your Medicare number like it’s a credit card.
4. Educate Yourself: Understanding the new Medicare rules regarding drug coverage can help seniors feel empowered and lessen the chance of falling victim to scams.

The Impact of Medicare Fraud

Medicare fraud is a serious issue; it is estimated that it costs taxpayers over $60 billion annually. Recognizing these fraudulent activities is crucial to protecting not only individual seniors but also the program as a whole. For years, StateWide has been at the forefront, implementing programs like the Fraud of the Month initiative to highlight these scams and keep the senior community informed.

In closing, as the 2026 changes come along, seniors and their caregivers must stay educated and vigilant. With StateWide's support through education, counseling, and reporting mechanisms, seniors can better arm themselves against scams.

For additional assistance, seniors can also connect with trained counselors through StateWide, who are ready to support them in understanding their Medicare options and rights. Protecting yourself and your loved ones from Medicare scams requires diligence and awareness, but with the right tools and knowledge, it can be achieved.