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5 Common Medicare System Complaints

June 9, 2021

The Medicare system is great because it provides much-needed healthcare to more than 44 million beneficiaries every year. However, it’s not perfect, and complaints are common. Signature Senior Solutions is here to help you navigate through this Medicare maze. We’re sharing five of the more frequent Medicare complaints we see so you can learn how to resolve them.

Complaint #1: Medicare Isn’t Paying My Medical Bills
Medical bill listing treatments, and end of stethoscope in top right corner.

Tell Medicare of any changes in your coverage as soon as possible!

This can happen to beneficiaries who enrolled in the Medicare system while they still had coverage through an employer.

When you belong to a plan through a workplace with more than 20 employees, Medicare becomes your secondary payer. When you leave your employer-sponsored plan, you (or whoever manages your benefits) notify Medicare of this change. Sometimes this doesn’t happen on time, so Medicare will still think they’re your secondary payer. They’ll send the bill back to your provider needing to be paid.

We recommend you tell Medicare about any changes in your coverage immediately, so you won’t be stuck in limbo later on. After you notify Medicare that they’re now your primary payer, ask your provider to resubmit the claim.

Complaint #2: My Part B Premium is Based on My Old Income

The Medicare system sets your Part B monthly premiums on your tax return from two years ago. That means that your 2021 premiums will be based on your 2019 income.

If your income was over $85,000 in 2019, you’ll pay a higher premium in 2021. However, if you retire, then you’ll be making less than your prior tax forms indicate. Since the higher premium won’t change for another two years, this can be frustrating.

The good news is you don’t have to wait it out. Medicare and Social Security allow you to appeal the cost of your income changes. Contact Social Security at 800-772-1213 to request an appeal.

Complaint #3: I’m Asked to Pay My Part B Deductible Twice

If only all healthcare providers understood the Medicare system billing process. Since they don’t, you might run into this common complaint.

When you have Medicare, your provider is supposed to bill Medicare first, even if you haven’t paid your deductible yet. You then pay any portion that wasn’t paid by Medicare. However, a provider may ask you to pay the Part B deductible upfront. If you do this, you might wind up being double-billed.

This can happen because the provider sent the bill to Medicare after you paid your deductible. Since Medicare doesn’t know you paid, they pay their portion minus your deductible and coinsurance amount. The provider then sends you the bill for the deductible amount.

This is a simple fix if you kept your receipts. Phone your provider’s office and remind them you paid the deductible on the date of service, and it will be fixed in no time.

Complaint #4: My Prescription Copay is Too High
Woman's hands with red nail polish, sorting through round white pills on her open palm.

Don’t get blindsided by prescription drug costs!

It can be a frustrating situation when you show up at the pharmacy to pick up your prescription, only to be met with a much higher cost than you were expecting. Here’s why that might’ve happened.

Prescription plans sort drugs into “tiers” or “steps.” Your copay amount depends on which tier your drug sits in. Generic and commonly prescribed drugs sit on the bottom tier and are the lowest in cost, but name-brand drugs without generic equivalents will be higher up on the system and require a higher cost.

If your prescription was more expensive than you expected, a good place to start is by talking to your drug plan, as they can tell you why that is. It could be your drug is on a higher tier. If that’s the case, ask your doctor if there’s a similar drug available on one of the lower tiers and if he can switch you over.

Complaint #5: Medicare Isn’t Paying for My Durable Medical Equipment

Just like with medical services, you must use a Medicare-approved supplier to get coverage for durable medical equipment (DME).

Medicare will only cover DME if you use a supplier provided by them. Our recommendation is to ask the supplier whether they’re Medicare-approved before choosing them for your DME.

Helping You Navigate the Medicare System

While these are only a few common complaints, we know there are lots more. Medicare is massive and ever-changing and can be confusing at the best of times. At Signature Senior Solutions, we are dedicated to helping resolve your Medicare complaints and questions and find the best coverage options for you.

Signature Senior Solutions is located in Cave Creek, and services all of Maricopa County and Arizona. If you’re out of state, don’t worry, we are multi-state licensed and are ready to service you as well!