Four Common Medicare Complaints And How To Fix Them

It isn't always easy to choose a Medicare insurance plan that's right for you. Even after you find a plan that seems to fit your needs, you may have complaints or be confused. Sometimes you just need help understanding there are solutions.

Here are four common complaints health care providers hear about Original Medicare (Part A + B), and some helpful ways to address them:

1. Original Medicare is not paying my claims

It’s become increasingly common for people to sign up for Original Medicare at age 65 while they’re still working and covered by their employer’s healthcare plan. In many such cases, Original Medicare serves as secondary coverage. That means if you go to the doctor and provide them your Medicare insurance information, the claim will likely be denied because you need to go through your primary insurance — the coverage you get from work — first. If your coverage has recently changed, it’s always a good idea to inform Medicare about the changes to ensure you have the coverage you need.

2. Original Medicare doesn’t include dental and vision

Many people sign up for Original Medicare without realizing that it doesn’t include coverage for services like dental and vision. These services can be critical to your overall wellbeing and they can come with significant costs.

3. Prescription drugs cost too much under Medicare insurance

Many people sign up for Original Medicare thinking it will include prescription drug coverage, only to be surprised by an expensive bill at the pharmacy. The fact is, Medicare Parts A and B do not include prescription drug coverage. For this, you will need to enroll in a separate Medicare Part D prescription drug plan or a Medicare Advantage plan that includes prescription drug coverage. If you already have Medicare Part D but your drug costs are still too high, you may be able to switch to a different Part D plan during a valid enrollment period. You may also want to talk to your doctor about switching to generic prescriptions that cost less. There is also a Medicare prescription payment plan option under the Inflation Reduction Act that requires all Medicare prescription drug plans to allow their enrollees to pay drug costs in the form of monthly payments verses all at one time at the pharmacy.

4. Medigap won’t pay for things Original Medicare insurance doesn’t cover

One common misconception regarding Medigap plans (also called Medicare Supplement plans) is that they will pay for medical services and equipment not covered by Original Medicare. In reality, Medigap is designed to pay for costs that Original Medicare doesn’t pay — but those costs only apply to covered services. If you’re looking for a service Original Medicare doesn’t cover, Medigap won’t pay for it either. To get coverage for extra services, a Medicare Advantage plan might be a good option for you. Although every plan is different, these plans may provide coverage for things that Original Medicare won’t pay for.

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