Aggressive marketing operations, comparable to infamous Wall Street “boiler rooms,” are subjecting people to a hard sell to try to get them to switch to a private Medicare Advantage plan.

This includes torrents of cold calls, which are expressly forbidden under Medicare regulations, and offers of “time sensitive” deals and discounts that are actually illegal.

Three quarters of senior citizens say they received cold calls trying to get them to switch to a Medicare Advantage plan during last year’s open-enrollment period, according to a groundbreaking survey conducted by the Commonwealth Fund, a nonpartisan think-tank.

Half of those surveyed, or 51%, told researchers that on these cold calls, the caller falsely claimed to be from Medicare.

“America’s seniors and people with disabilities … should be protected from bad actors who engage in misleading advertising and marketing tactics,” said Dave Allen, a spokesman for America’s Health Insurance Plans, the trade association and lobby group that represents private-sector insurers, in a statement. “Health insurance providers strongly agree: Americans should have clear, accurate, easy-to-understand information about Medicare Advantage plans, so they know what they are buying.”

Allen added that the industry will be subject to tougher regulations this year. “AHIP will continue to engage with [the federal Centers for Medicare and Medicaid Services] and other stakeholders to assess Medicare marketing requirements including addressing certain elements to ensure they do not hamper the ability of agents and brokers to assist Medicare enrollees in choosing the best coverage option for them,” he said.

Medicare Advantage, in which Medicare is outsourced to for-profit insurance companies, is big business. It has been growing rapidly for more than a decade and this year for the first time exceeded the size of traditional, government-run Medicare. Last year, taxpayers paid Medicare Advantage insurers just over $400 billion, in addition to money paid through the Medicare Part D prescription-drug program, according to the government’s Medical Payment Advisory Commission.

Hard-sell tactics are being focused especially on seniors with lower incomes, the Commonwealth Fund reports. Those with incomes of less than $25,000 a year were twice as likely as those with higher incomes to be asked for their Social Security or Medicare numbers before being given any plan details, the survey reports. That’s against Medicare rules, Jacobson noted. And 28% of those with lower incomes said they’d been exposed to marketing or advertising that claimed something about a private Medicare Advantage plan that they later found out wasn’t true — a much higher percentage than among other income groups.

Jacobson said people with low incomes are often especially profitable to Medicare Advantage providers, because they are eligible for both Medicaid and Medicare.

Seniors are struggling with the bewildering complexity of the Medicare program as well as hard-sell tactics. MedPac reports that last year, Medicare Advantage included 5,261 plan options offered by 182 organizations. According to the survey, the choice is so overwhelming that many seniors choose to simply stay with their existing plan.

“It’s concerning that these things are happening,” Jacobson said. “This is an overwhelming but very high-stakes process, with important financial implications for beneficiaries.”