Medicare provides valuable health coverage to millions of Americans, but that doesn’t mean everything always goes smoothly.

Sometimes the problem is a confusing bill. Sometimes a prescription costs more than expected. Maybe your doctor isn’t accepting your plan, Medicare denied a claim, or you’re not sure why you’re being charged for something you thought was covered.

These situations can be frustrating—and trying to solve them on your own can make them even more stressful.

At Life and Med: Medicare Resource Center, we believe you shouldn’t have to navigate every Medicare question by yourself. A local Medicare broker can help you understand your coverage, investigate certain issues, and point you in the right direction when a problem comes up.

Here are 7 common Medicare complaints and what you can do about them.

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1. “Why Am I Being Charged for My Medicare Part B Deductible?”

One frustrating situation occurs when a beneficiary believes they’ve already paid their Part B deductible, only to receive another bill asking for the deductible.

This can happen because Medicare applies the deductible based on when claims are submitted and processed.

For example, you may pay a provider expecting that payment to satisfy your deductible. However, another healthcare provider or laboratory could submit a claim to Medicare first. Medicare may then apply the deductible to that claim instead.

That can leave you wondering why another provider is asking you for the same amount.

How Life and Med Can Help

When you receive a Medicare bill that doesn’t seem right, don’t simply ignore it.

A Medicare professional can help you understand how the claim was processed and determine whether you need to contact the provider, Medicare, or your insurance company.

Keep your Medicare Summary Notices, Explanation of Benefits documents, and provider bills. Having those documents available can make it much easier to figure out where a billing problem occurred.

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2. “Why Is My Medicare Premium Higher Than I Expected?”

Another common complaint is an unexpectedly high Medicare Part B or Part D premium.

Some beneficiaries are surprised to discover that their Medicare premiums can be affected by their income.

This is known as IRMAA—the Income-Related Monthly Adjustment Amount.

Medicare generally uses tax-return information from two years earlier when determining whether an income-related adjustment applies.

That can create a frustrating situation for someone who has recently retired or experienced a significant reduction in income.

For example, your tax return from two years ago may show a much higher income than what you’re earning today.

What Can You Do?

If you’ve had a qualifying life-changing event that caused your income to decrease, you may be able to ask Social Security to reconsider your IRMAA determination.

Depending on your circumstances, documentation may be required.

How Life and Med Can Help

We can help you understand what IRMAA means, discuss the general reconsideration process, and help you identify the appropriate next step.

If you’re paying an income-related Medicare surcharge and your financial situation has changed, don’t assume there’s nothing you can do.

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3. “Why Am I Getting So Many Bills With My Medicare Advantage Plan?”

Medicare Advantage plans often use copayments and coinsurance for healthcare services.

You might pay one copay when you visit your doctor and then receive another bill because you were sent to a laboratory or another healthcare provider.

That can make your healthcare expenses feel unpredictable.

For someone who doesn’t understand how their Medicare Advantage plan works, the costs can come as a surprise.

How Life and Med Can Help

When reviewing Medicare Advantage coverage, it’s important to look beyond the monthly premium.

We can help you compare factors such as:

• Primary care copays
• Specialist copays
• Hospital costs
• Outpatient services
• Prescription costs
• Maximum out-of-pocket limits
• Provider networks

During an applicable enrollment period, we can also help you compare other available Medicare options.

The plan with the lowest premium isn’t necessarily the plan with the lowest overall healthcare costs.

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4. “Why Did My Prescription Cost So Much?”

You arrive at the pharmacy expecting to pay one amount—and suddenly you’re being asked to pay much more.

Sound familiar?

Prescription costs can vary depending on how your Medicare drug plan categorizes a medication.

Your plan’s formulary determines which medications are covered and how they are classified.

A medication placed on a higher tier may have a higher cost to you.

Other factors can also affect what you pay, including:

• Your plan’s deductible
• Drug tier
• Copayment
• Coinsurance
• Preferred pharmacy
• Quantity limits
• Prior authorization requirements

How Life and Med Can Help

We can review your prescription coverage and help you understand why a medication may have a particular cost.

In some circumstances, your doctor may be able to request a tier exception or determine whether an appropriate alternative medication is available.

Never stop taking a prescribed medication simply because the price is too high. Talk with your healthcare provider about your options.

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5. “Why Isn’t Medicare Paying for My Medical Equipment?”

Medicare can cover certain types of durable medical equipment (DME) when specific requirements are met.

Examples may include:

• CPAP equipment and supplies
• Blood glucose monitors
• Walkers
• Wheelchairs
• Other qualifying medical equipment

One common source of confusion is using a supplier that isn’t approved or contracted for your particular Medicare coverage.

How Life and Med Can Help

The process can depend on what type of Medicare coverage you have.

If you’re enrolled in Medicare Advantage, you generally need to use a supplier that participates in your specific plan’s network.

If you have Original Medicare with a Medicare Supplement, Medicare’s supplier requirements may apply.

Before ordering expensive medical equipment, check whether the supplier is approved or in-network for your coverage.

Doing this beforehand can help prevent an unpleasant surprise later.

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6. “Why Isn’t My Medicare Supplement Paying My Bill?”

Here’s an important Medicare fact that sometimes surprises people:

A Medicare Supplement plan does not automatically pay for every service Medicare doesn’t cover.

Medicare Supplement insurance generally helps pay certain Medicare-covered cost-sharing amounts, such as deductibles, copayments, and coinsurance.

If Medicare denies a service because Medicare doesn’t cover that service, your Medicare Supplement generally won’t simply step in and pay the bill.

What Can You Do?

First, find out why Medicare denied the claim.

Was the service:

• Not covered by Medicare?
• Billed incorrectly?
• Missing required information?
• Subject to a coverage rule?
• Considered medically unnecessary under Medicare’s rules?

How Life and Med Can Help

We can help you understand the explanation you received and determine what questions you should ask Medicare or your healthcare provider.

Sometimes a billing problem is simply a matter of a claim being submitted incorrectly.

Understanding why something was denied is the first step toward determining what to do next.

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7. “I Just Started Medicare—Why Isn’t Medicare Paying My Doctor’s Bills?”

This can be especially confusing when you’re newly enrolled in Medicare.

You may have received your Medicare card, presented it to your doctor’s office, and expected Medicare to pay the claim—only to discover that the claim was denied.

One possible reason is that Medicare’s records may still show another insurance plan as your primary coverage.

This can happen when someone:

• Retires after age 65
• Leaves employer coverage
• Changes employer coverage
• Transitions from employer insurance to Medicare

How Life and Med Can Help

When Medicare’s records don’t accurately reflect which insurance should pay first, the claim can end up in the wrong place.

Getting the coordination of benefits corrected may require contacting Medicare and your former employer’s insurance administrator and then having the healthcare provider resubmit the claim.

A Medicare professional can help you understand what information needs to be corrected and where to start.

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