As you can imagine there are common Medicare complaints that many seniors express. Well, today we’ll go over the issues many people just like you face with Medicare.
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. Some patients experience claim denial or things end up costing more.
The Most Common Medicare Complaints
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 Part D Complaints
My prescription copay is 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.
Medigap isn’t 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 Original Medicare. If Medicare doesn’t cover a service, then Medigap won’t cover it either.
Common Medicare 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.
In addition, there are 10 Medigap plans, and they vary in the amount of coverage they provide. Some require a copay or only pay a percentage of your out of pocket costs.
Our client care team can help you understand your Medigap coverage, shop for a different plan, and find a supplemental hearing, vision, and dental insurance.
Traditional Medicare Complaints
Medicare isn’t 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.
In addition, in many states, you must buy or rent your equipment from a Medicare-approved supplier or it might not have coverage.
Our client care team can help you understand what equipment has coverage and help you find a supplier, so you’ll get the most from Medicare. We can help our clients through many of the common Medicare complaints.
Higher Medicare Part B Premiums
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, but it’s 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.
Medicare Advantage Complaints
My costs are 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.
Medicare Advantage plans may 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.
With some Medicare Advantage plans, you must have a referral before the plan will cover 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 alternate coverage the next time you’re eligible to switch plans.
Have Experts in Your Corner 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.