SOLVING THESE 7 MEDICARE POST-ENROLLMENT COMPLAINTS

Michael T. Braden May 6, 2026 MEDICARE 101

HOW BRADEN MEDICARE INSURANCE ASSISTS YOU IN SOLVING THESE 7 MEDICARE POST-ENROLLMENT COMPLAINTS

Medicare is the National Health Insurance for Americans 65 and older, and for some with an approved disability designation from the Social Security Administration. With well over 70 million people enrolled in Medicare. As you can imagine, some beneficiaries have Medicare complaints that are difficult to resolve on their own.

Whenever this happens, Braden Medicare is right by your side. We will work with you, using our knowledge and expertise, to resolve any Medicare issues quickly and efficiently.

Picture Of Braden Medicare Insurance's 7 Common Medicare Post-Enrollment Complaints Poster

MY DOCTOR'S OFFICE IS ASKING ME TO PAY MY PART B DEDUCTIBLE, EVEN THOUGH I'VE ALREADY PAID IT.

Oftentimes, doctor offices aren’t as well-versed in Medicare as you would expect. They know that Medicare Part B has an annual deductible that patients must pay out of pocket.

However, it’s common for an office to ask you to pay the deductible the same day as your appointment. Then the following week, you receive a bill from your doctor’s office that says you still owe your Part B deductible.

HOW WE WORK WITH YOU TO RESOLVE THIS ISSUE: 

This happened because Medicare had no way of knowing you already paid your deductible to the doctor. The doctor’s office must submit your claim to Medicare first. When billed this way, Medicare will process the claim without recording that you have met your deductible.

Another way this happens is that you pay your deductible to the doctor, but another provider, often a lab facility, bills Medicare first.

Medicare processes the claim for the other provider minus the deductible, and then that provider bills you for the deductible. You must ask your doctor to refund the deductible to you since Medicare applied it to a different claim. When our clients contact us about an unexpected bill, we contact the doctor first to understand why. After determining the issue, we will work with Medicare and the doctor’s office to resolve it. We do this by requesting that the doctor’s office reimburse the client in full for the Part B deductible ($283 in 2026). The client then uses that money to pay the deductible to the correct provider.

Medicare and the doctor’s office to correct it. We do this by requesting that the doctor’s office reimburse the client for the $283 (2026 Part B deductible). The client then uses that money to pay the deductible to the correct provider.

WE RECOMMEND THAT YOU ASK ALL OF YOUR DOCTORS TO BILL MEDICARE FIRST, TO REMOVE ANY CONFUSION AND THE POTENTIAL FOR PAYING YOUR DEDUCTIBLE TWICE.

I HAD TO PAY A HIGHER PREMIUM FOR PART B AND PART D, BUT I DO NOT MAKE THAT MUCH ANYMORE

Medicare sets your Part B and Part D monthly premiums based on your tax return from two years prior. As of 2026, if you made more than $109,000 annually two years before, you would pay a higher premium for Part B and Part D, also known as an IRMAA (Income-Related Monthly Adjustment Amount) charge. However, when Medicare beneficiaries retire, they’re usually making less than what their prior tax forms indicate. This higher premium can be frustrating for beneficiaries.

HOW WE WORK WITH YOU TO RESOLVE THIS ISSUE: 

We walk our clients through the IRMAA appeal process, which involves submitting an SSA-44 form to request reconsideration. The Social Security office reviews the form along with related documentation and decides whether to reduce the premium. Many of our clients have successfully lowered their Medicare premiums this way.

MAKE SURE YOU ALWAYS HAVE COPIES OF YOUR PAST TWO FEDERAL TAX RETURNS 7 ANY W-2’S IN CASE YOU NEED TO REQUEST A HEARING FROM SOCIAL SECURITY TO REMOVE YOUR IRMAA SUR-CHARGES

I GOT HIT WITH UNEXPECTED CHARGES FROM MY MEDICARE ADVANTAGE INSURANCE PLAN

When enrolled in Medicare Advantage, you’ll pay for copays and coinsurance for services as you go along. For example, your doctor’s copay might be $40, but then they send you down the hall for bloodwork, so you get hit with another copay from the lab. This makes out-of-pocket expenses under Medicare Advantage plans hard to predict and often causes them to exceed your original budget.

HOW WE WORK WITH YOU TO RESOLVE THIS ISSUE: 

Sometimes, when you enroll on your own without fully understanding how Advantage plans work, you may find that you’re spending more money out-of-pocket for your Advantage plan than you had anticipated. The reality is, one visit can cost you multiple copays and/or coinsurance if you have more than one provider billing Medicare.

We assist our clients by comparing other Medicare Advantage plans in your area to see if we can lower your costs and reduce your exposure. We can also look at other types of plans, such as Medigap plans, that could significantly reduce your out-of-pocket spending and eliminate doctor copays.

REFER TO YOUR PLANS SUMMARY OF BENEFITS (SOB) TO KNOW EXACTLY WHAT YOU ARE RESPONSIBLE FOR

MY PART D CO-PAY IS HIGHER THAN IT IS SUPPOSED TO BE

You get to the pharmacy to pick up a prescription, and the pharmacist informs you that you owe more than you expected. Sometimes the price the pharmacy charges is right, other times it’s wrong.

HOW WE WORK WITH YOU TO RESOLVE THIS ISSUE: 

We will contact your insurer and investigate whether you’re supposed to pay that price. Often, we confer with the drug plan company for an explanation. One reason the price may be higher than you expected is that the medication is a higher-tier drug. Typically, the higher the tier, the higher the cost, as confirmed by your plan’s drug formulary.

If this is the case, there are a couple of ways to resolve the issue. We can help you call your doctor to submit a tier reduction request to your plan’s carrier. Alternatively, you can ask your doctor to prescribe a similar drug in a lower tier.

ASK YOUR DOCTOR WHAT GENERIC OPTIONS ARE AVAILABLE & MAKE SURE HE KNOWS WHAT YOUR PART D PLAN IS

MEDICARE IS NOT PAYING FOR MY DME (DURABLE MEDICARE EQUIPMENT)

Our Braden Medicare Insurance clients, especially our newest clients, may not realize they need to use a Medicare-approved supplier to receive coverage for durable medical equipment (DME), such as glucose monitors, CPAP supplies, and more.

Medicare will only cover DME (Durable Medical Equipment) if you use a supplier approved by them.

HOW WE WORK WITH YOU TO RESOLVE THIS ISSUE: 

The way we solve this issue often depends on the type of Medicare plan a client has. For instance, with a Medicare Advantage plan, we’d contact the carrier to find a contracted supplier approved by the plan.

If our client has a Medigap plan, our team will help find a Medicare-contracted supplier and guide the client through the process of obtaining their supplies.

MAKE SURE YOU ONLY RECEIVE MEDICARE EQUIPMENT FROM A MEDICARE APPROVED SUPPLIER

WHY IS MY MEDICARE SUPPLEMENT/MEDIGAP PLAN NOT COVERING CHARGES THAT MEDICARE DENIED?

Many beneficiaries think that Medigap plans cover all services and procedures Medicare doesn’t, but that isn’t true. Medigap plans only pay for deductibles, copays, and coinsurance on claims that Medicare has approved first.

Unfortunately, if Medicare doesn’t cover a service, the Medigap plan cannot make any payment on the claim either.

If Medicare doesn’t cover the service, the supplement is not allowed to make any payment on the claim either.

HOW WE WORK WITH YOU TO RESOLVE THIS ISSUE: 

In this situation, our team makes sure the claim was billed correctly to Medicare. If it was, and still is, denied, we find out why. Then we educate you so that you don’t run into this problem again. We can give you a refresher on services Medicare doesn’t cover, such as routine foot care or cosmetic procedures.

If the claim was billed incorrectly, which happens often, we work on your behalf to resolve this issue by contacting Medicare and your doctor’s office to ensure that the claim is resubmitted correctly.

MEDICARE SUPPLEMENTS ONLY COVER MEDICARE APPROVED SERVICES

I SURVIVED THE MEDICARE ENROLLMENT PROCESS, BUT I DON'T KNOW WHY MEDICARE IS NOT PAYING MY DOCTOR'S BILLS

People who delayed Medicare past age 65 or recently left employer coverage often run into this problem. They visit the doctor for a checkup and present their Medicare card, thinking that Medicare is now their primary coverage.

This usually happens because Medicare’s records still show the old employer insurance as the primary payer. If the employer fails to notify Medicare that you are no longer employed there, Medicare will reject the claim because it believes the group insurance plan is still the secondary payer.

HOW WE WORK WITH YOU TO RESOLVE THIS ISSUE: 

We will offer to resolve this issue by placing a conference call with the client and Medicare to ensure their systems reflect that Medicare is, in fact, primary. Then we will contact the doctor’s office to have them resubmit the claim so Medicare can pay its share.

MAKE SURE MEDICARE IS YOUR PRIMARY INSURANCE

WRAPPING THINGS UP

At the end of the day, Medicare is not perfect. And they are not exempt from Medicare Billing Issues. As beneficiaries have these dicare complaints, it is all the more important to have an advocate like Boomer Benefits on your side.

MOST PROBLEMS HAVE EASY ANSWERS WHEN YOU KNOW WHO TO TALK TO AND WHERE TO LOOK

Thank you for reading this article about avoiding the 7 Most Common Medicare Post-Enrollment Mistakes. If you have any questions about this article or need help with anything related to Medicare and are not sure who to call, please feel free to email me directly at mike@bradenmedicare.com, 24/7 on our website at www.bradenmedicare.com, or simply give me a call at 480-225-1393.