Common Medicare Complaints & How We Resolve

While Medicare offers much-needed coverage for healthcare, if beneficiaries had zero complaints, it would be surprising. Fortunately, most problems are pretty easy to solve. In this article, we look at the most common issues we see about Medicare.

I'm asked to pay twice for my Medicare Part B deductible

Both healthcare providers have a full understanding of the Medicare billing process in an ideal environment and implement it.

Your insurer is expected to bill Medicare first because you have Medicare, even though you have not yet paid the deductible. Then you pay the part that either Medicare or your Medigap plan does not cost.

Your provider will ask you, particularly if they are not familiar with Medicare, to pay the Medicare Part B deductible upfront. You will end up being double-billed if you do this. There are two ways that this could occur.

The first is that the insurer sent the bill to Medicare after the deductible was paid by you. Medicare doesn't know you paid it, so they pay the premium and co-insurance balance minus their part. For the deductible sum, the company then gives you a bill.

It is fairly easy to fix this, provided you keep your receipts. You literally phone the office of the provider to inform them that on the date of service you paid the deductible.

When you pay your deduction to the provider, but then visit a specialist or laboratory, the second scenario happens. Sometimes, the second provider bills Medicare first (this is especially true in the event of lab work). Again, Medicare doesn't realize if the premium has already been paid. So, Medicare pays their part minus the Medicare Part B deductible when the second provider sends in their bill. And the second provider, of course, gives you the bill for the remainder.

It is a little more difficult to overcome this second situation, as it needs the first provider to refund the deductible.

You completely prevent this issue by telling the company that they must first bill Medicare.

For all services received, Medigap did not reimburse my provider

Medicare Supplement insurance Plans help cover a range of expenses. It only accounts for services that are provided by Medicare, however. In other words, you can't pay for a tummy tuck, dental implants, eyeglasses, or any other treatment not provided by Medicare using the Medigap account.

If you're confident that the service is covered by Medicare, the problem could be a billing mistake. Contact your provider to make sure that the service has been properly billed.

Medicare doesn't cover my bills for my medication

For individuals who enrolled in Medicare because they already had coverage through an employer (either theirs or their spouse's), this problem is more common. Usually, it happens when nobody tells Medicare that the previous coverage has ended.

Medicare is the secondary payer when you belong to a group through a workplace with more than 20 workers. As you leave your employer-sponsored plan, whoever handles your insurance should contact Medicare. This does not always happen in a timely manner, though, which means that Medicare still assumes it pays second, so they give the bill back, unpaid, to the provider.

Also Read : Medicare Plan Terms Employers Need to Know

Notify Medicare about any coverage adjustments. Ask the insurer to resubmit the claim after you tell Medicare that they're the primary payer.

My Co-Pay Prescription Is Too High

Your Medicare Part D coverage should include a drug formulary, which is basically a list of prescriptions covered. It possibly also uses a tier or phase structure where, along with the levels, drug prices increase.

Medicare Part D plans almost always change the formulary from year to year. That's why we suggest carefully reviewing the plan’s Annual Notice of Change (ANOC). Otherwise, if your insurer avoids covering one of your prescriptions, you would not know. Until it's time, of course, to fill it up.

Start by consulting your drug plan if your prescription is more costly than you expected. They will say why to you. It could be that the prescription is at a higher tier. It may also be that one of their chosen suppliers is not your pharmacy. Ask your doctor to make a request for a tier reduction if it is a tiered issue. Another choice is to inquire if one of the lower tiers has a similar medication available.

My Medicare Part B Premium is based on my old income

On your income tax return from 2 years ago, Medicare bases your monthly Part B premium. That means your premium for 2019 is based on your income for 2017.

In 2019, you pay a higher premium if your 2017 compensation was over $85,000 per year (filing individual or married filing separately) or over $170,000 per year (married filing jointly). This is defined as and is added to your monthly premium as an Income Related Monthly Adjustment Amount (IRMAA). According to your income level, the IRMAA differs. Every year it changes.

Of course, most individuals, after they retire, experience a shift in income. And few want to wait two years for Medicare to catch up with its new level of income. That's why, if your income changes, Medicare and Social Security allow you to appeal to IRMAA.

Contact Social Security at 800-772-1213 to appeal. Within 60 days of obtaining your IRMAA notice, you will apply for an appeal.

My out-of-pocket expenses are too high for my Medicare Advantage Plan

One reason we suggest partnering with a broker, like Medicare Services is to help make sure you fully understand the expenses of your Medicare Advantage (MA) plan.

While all MA programs have to cover the same services and benefits as Original Medicare, there is no standardization in their out-of-pocket costs. And if you also need blood, x-rays, or more, a single visit to your primary care doctor can cost you several co-pays.

That's why when searching for an MA package, we suggest comparing ALL of the plan's prices, not just the monthly premium.

Medicare Services' licensed agents will help you to find the right option for you for Medicare Advantage or Medigap. Just call us at (844)731-6614. Or compare medicare plan options in your area.

How To File A Medicare Complaint

If you are not pleased with the level of service or treatment that you have received from one of your providers, you can file a Medicare complaint. Often known as a grievance, a complaint is explicitly aimed against your provider or plan.

Beneficiaries of Medicare can file a complaint about their medical doctors, drug plan, and essentially any agency you rely on for health services. Speak with the SHIP office of your state to file a complaint.

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