The Medicare Fraud of the Month for January

ALBANY, N.Y., Jan. 13, 2026 /PRNewswire/ — The New York StateWide Senior Action Council (StateWide), a 54-year-old non-profit organization dedicated to serving the needs and well-being of our State’s more than 3.6 million senior citizens, today announced its Medicare Fraud of the Month for January: Scams Involving the Medicare 2026 Prescription Cap.

The StateWide Fraud of the Month is a component of the Senior Medicare Patrol (SMP), the definitive resource for New York State’s older adults and caregivers to detect, prevent, and report healthcare fraud, errors, and abuse. StateWide is New York’s grantee/administrator for this Federal Program.

Maria Alvarez, Executive Director of StateWide, advises seniors to be aware of the new Medicare rules concerning drug coverage. “Medicare drug coverage (Part D) can be confusing, and many people still worry about the “donut hole,” # even though it no longer exists. Scammers know this and may use Medicare drug changes as an excuse to contact you. Knowing the facts can help you save money and avoid costly scams.”

About the 2026 Medicare Prescription Drug Cap:

The Medicare Part D coverage gap (“donut hole”) has been eliminated.
In 2026, there is a $2,100 yearly limit on what seniors pay out of pocket for covered prescriptions.
- Once the cap is reached, Medicare Part D recipients pay nothing more for covered drugs for the rest of the year.
A voluntary payment plan lets seniors spread drug costs evenly over the year instead of paying large amounts at the pharmacy.

How Seniors Can Protect Themselves from Scams

Beware of unsolicited phone calls claiming to offer assistance with Medicare Part D benefits, especially if they ask for personal information like a Medicare number.
Scammers may tell you that in order to qualify for the new cap, you need to pay an upfront fee or “processing” fee.
- Remember, no legitimate Medicare program will ask for payment before benefits can be accessed
If enrolled in a Medicare Prescription Payment Plan, nothing extra is required to be shown (like an additional card) when picking up prescriptions at the pharmacy.
- Instead, enrollers will get a monthly bill from subscribed health or drug plans.

Seniors who have questions about the 2026 Medicare changes or need to report suspected Medicare fraud, StateWide certified counselors are ready to help.

“If you suspect your Medicare number has been compromised or you’ve been enrolled in a plan without your permission, contact the New York State Senior Medicare Patrol (SMP) at 800-333-4374, or visit www.nysenior.org. We have trained counselors to help Medicare beneficiaries in the fight against fraud,’ Alvarez concluded.

StateWide also provides information and educational presentations, assistance regarding any Medicare questions, plan comparisons, appeals, billing issues and patients’ rights to all seniors throughout New York State.

It is estimated that Medicare fraud costs taxpayers over $60 billion dollars nationally per year. To help combat this illicit industry StateWide announced its Fraud of the Month program in 2022 to highlight these scams being perpetrated on the State’s seniors.

# About the “donut hole.” Medicare discontinued the Medicare Part D donut hole as of 2025. The donut hole was a gap in prescription drug coverage, where an insured person had to pay more for prescription drugs.

A new out-of-pocket cost cap has replaced the Medicare Part D donut hole as of 2025. Beneficiaries will not have to pay for prescription drugs for the remainder of the year once they reach $2,100 in 2026.

Additionally, Medicare has introduced a prescription payment plan option that enables individuals to spread their prescription costs over the year.

SOURCE New York StateWide Senior Action Council, Inc.

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