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The Medicare Rights Center Announces Top 3 consumer Medicare concerns

The Medicare Rights Center is a national service organization whose mission is to help older Americans receive affordable healthcare and deal with consumer Medicare concerns. It offers counseling and educational programs and works to bring about positive change through advocacy, working with policy makers and the Centers for Medicare and Medicaid Services.

The Center recently published a report on topics addressed through its National Consumer Helpline in 2016. The Helpline staff fielded close to 17,000 questions concerning Medicare rules and coverage that year. 

Three issues rose to the top:

  1. Confusion about Medicare Part B enrollment, especially when switching from other coverage, such as COBRA.
  2. Questions about Medicare Advantage plans, particularly rules about coverage and denials of coverage.
  3. Affordability issues in the face of rising Medicare Part D drug costs.

Confusion about Medicare Part B enrollment occurs because there is no formal notification process about enrollment. It is up to the individual to figure it out. For people who are already receiving Social Security benefits, this is not an issue as Part B enrollment is automatic. Medicare Part B is medical insurance as opposed to hospital insurance covered under Part A.

People who have deferred Social Security benefit payments must enroll in Part B during an enrollment period. An Initial Enrollment Period occurs three months before turning 65, the month of the birthday and three months following. There is also a general enrollment period, from January 1 to March 31.

If a person enrolls late, i.e., outside of enrollment periods, there is a penalty charged. A fee will be added to the monthly cost of Part B for the remainder of the coverage period.

If a person is still working and has deferred Social Security benefit payments but wants to switch healthcare coverage to Medicare, Part B enrollment is not automatic. In this case, the person must enroll during a specified enrollment period. It is possible to delay enrollment in Part B if the person has coverage elsewhere. In this case, there will be no penalty.

No wonder people are confused! Medicare Rights strongly supports a bi-partisan act introduced in Congress last year. The Beneficiary Enrollment Notification and Eligibility Simplification Act (BENES) would notify individuals clearly about enrollment rules and how Medicare works with other insurance.

The second most frequent issue people called about was denials of coverage for necessary medical services. Most dealt with Medicare Advantage (40%), followed by Part D (35%), Part B (35%), and Part A (9%).

The third most important issue stated by consumer Medicare concerns on the Helpline was the affordability of drugs under Medicare Part D. Medicare beneficiaries were looking for information about receiving help with the costs. Since the Extra Help program’s income limits are unrealistically low, most did not qualify for financial assistance. This is an issue that will continue to grow as drug prices steadily increase.

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