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The Most Common Medicare Complaints

There are common Medicare complaints that many enrollees express.  Choosing Medicare coverage can feel stressful, and it’s a big relief when you finally enroll. But it’s not always smooth sailing after that. Medicare can cost more than most people are prepared to pay. Cost is a common complaint among enrollees, as well as coverage. There are times when people thought the coverage was enough, and that just wasn’t the case. Below we discuss some of the top Medicare complaints we see from clients.

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Medicare Advantage Complaints

Why are my costs higher than expected with my Medicare Advantage plan?

Medicare Advantage plans are offered through private insurance companies, and different companies and plans have different rules, copays, deductibles, and coinsurance. Sometimes your costs are higher than expected because your plan denied a claim it should have paid. But sometimes your plan doesn’t work the way you thought it would.

Do Medicare Advantage plans have different out-of-pocket costs than Original Medicare?

Medicare Advantage plans have provider networks, and you’ll pay more if you see a provider who is not in your plan’s network. Advantage plans account for a large number of common Medicare complaints because out-of-pocket costs are different.

With some Medicare Advantage plans, you must have a referral before the plan covers a visit to a specialist. If you buy a Medicare Advantage plan through us, our client care team can help you understand why your costs were not what you expected, and we can help you shop for other coverage the next time you’re eligible to switch plans.

Medicare Part D Complaints

Why is my prescription copay higher than I expected?

Medicare Part D Prescription Drug plans sort drugs into “tiers,” and your copay amount depends on which tier your drug belongs in. Generics and other drugs in lower tiers usually have a flat copay, but for higher-tier drugs, you may pay either a copay or a percentage of the cost.

If your prescription is more expensive, it’s usually because your medication is in a different tier than the ones in the past. But sometimes there’s a mistake. Our client care team can help you understand your drug charges and guide you through resolving any issues you have.

Medicare Supplement Complaints

Why isn’t Medigap paying the charges that Medicare didn’t pay?

Many people don’t understand that Medicare Supplement Plans (Medigap) cover the same services as Medicare. If Medicare doesn’t cover a service, then Medigap won’t cover it either.

Common Medigap complaints are really just misunderstandings of coverage. Having an agent that understands your needs is very important. For example, if you see a specialist for a medical condition, Medicare will pay 80 percent of the cost of that doctor visit. A Medigap plan can pay the other 20 percent. But if you need hearing aids, neither Medicare nor Medigap will pay for them.

Original Medicare Complaints

Why isn’t Medicare paying for my medical equipment?

Medicare covers certain types of medical equipment that you use at home as “durable medical equipment.” This includes oxygen, walkers, and wheelchairs. However, some equipment doesn’t have coverage, such as adult diapers or grab bars for your shower.

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Also, in many states, you must buy or rent your equipment from a Medicare-approved supplier, or it might not have coverage.

Why are my Part B premiums higher?

Most people pay a standard premium for Medicare Part B coverage. The trouble with this is that Medicare looks at your tax return from two years ago to determine your income. Recent retirees can end up paying extra because their income when they were working is higher than their income is now.

The solution to this is to file a request for reconsideration with the Social Security office, asking them to lower your Part B premium. We can walk you through what you need to do to start the process.

I recently got Medicare, why are they not paying my claims?

Usually, when this happens, it’s because you have employer health insurance, and Medicare doesn’t know about your retirement. We can help you sort this out, so you get the coverage you need.

Is Medicare a ripoff?

When you consider the cost of Marketplace coverage or employer health insurance, Medicare is not a ripoff. Most people will pay more in premiums when they’re under 65 than when they turn 65.

How to Get Help When Medicare Complaints Arise

Medicare is complicated, and healthcare providers and insurance companies don’t always get things right. At MedicareFAQ, we want to help you understand Medicare and call us with any complaint, common or not. If you’re shopping for coverage, we can help you find and compare plans in your area. Give us a call or fill out our form, and we’ll start searching policies right away.

Jagger Esch

Jagger Esch

Medicare Educator
Jagger Esch is the Medicare Educator for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.
Ashlee Zareczny

Ashlee Zareczny

Compliance Manager
Ashlee Zareczny is the Compliance Manager for MedicareFAQ. As a licensed Medicare agent in all 50 states, she is dedicated to educating those eligible for Medicare by providing the necessary resources and tools. Additionally, Ashlee trains new and tenured Medicare agents on CMS compliance guidelines. Ashlee is a Medicare expert who specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D education.

One thought on "The Most Common Medicare Complaints"

  1. just received my premium for Part D supplemental coverage from United Healthcare for 2024- premium MORE THAN DOUBLED from 2023! with the Biden plan to lower drug costs all that happened was that supplemental insurance companies skyrocketed their rates so no cost savings was passed on to the Medicare recipient


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