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The Most Common Medicare Complaints

There are common Medicare complaints that many seniors express.  Choosing Medicare plans 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 prepare for paying. Cost is a common complaint among seniors, 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.

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?

Prescription 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, or Medigap, plans to 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 oxygen, wheelchair, or other 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.

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 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 Obamacare 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’ll give you a free quote. Give us a call or fill out our form, and we’ll start searching policies right away.

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Lindsay Malzone

Lindsay Malzone is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.


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