r/medicare

Hi my sister is on straight Medicare and went to urgent care for burned finger . It was a bad burn . Why did Medicare reject the claims I read there are no network limitations with straight Medicare . Her bill is 700 Thanks for any insight

Medicare part B expects you to enroll at age 65 and assesses a 10% penalty per year you do not file/apply.

In this case a couple were living overseas (foreign citzens). The husband was getting Social Security based on working in the US decades ago. Upon his passing, the widow moved back to the US and acquired a Green Card and then Citizenship. After getting her Green Card, she applied for benefits and started getting the SSA survivor benefit payment, and Medicare Part B coverage at age 85. However, SSA decided that she has to pay a 200% penalty for not signing up 20 years prior at age 65.

Per AI (and common sense fairness...):

According to the Social Security Administration (SSA) POMS (Program Operations Manual System) HI 00805.005, to be eligible for Medicare Part B based on age, an individual must:

1. Be age 65 or older;
2. Be a U.S. resident; AND
3. Be either a U.S. citizen OR an alien lawfully admitted for permanent residence who has resided in the U.S. continuously for the 5 years immediately preceding the month of filing.

As she was not eligible for Medicare Part B until she became a Permanent Resident, is it correct / legal for them to assess a 200% penalty for the 20 years when she was legally prohibited for being a Medicare Part B recipient? i.e. she would have been paying monthly premiums for a program that she was not eligible to use.

Has anyone encountered this situation? Any adivice?

Which Insurance Company is a stable company for High Deductible Plan G in Arizona?

I am in the process of retiring at age 68 and already signed up for Medicare, a supplement plan, and Part D. The issuer of my Part D plan has never come back and asked for proof of creditable coverage during the time that I was on employer insurance after age 65. I have the letters my employer sent me for those years. Why has nobody asked for this?

We kept getting calls from them to schedule an appointment. I’d never heard of them before so I ignored. Then we got the letter stating they couldn’t schedule with us so they’ll let Medicare know we were unresponsive. We have a pcp already and I think there are a lot of sim l preying on older people. So I’m leary.

This is not a question about the differences between the 2 drugs.

Both drugs are approved as part of the Medicare $50/month Bridge program starting in July. My question is simple.........

After the Bridge program ends on December 31st, which drug is more likely to be picked up by Part D insurers when the Balance program begins on January 1st? I know this question can't be answered definitively, but does anyone have any thoughts as to which drug Part D insurers are more likely to get behind? Or would they just cover both as an extension of the Bridge program?

The reason I ask is if 1 drug is more likely to be approved starting January 1st, that's the drug I will start in July. I'd rather not start one drug in July then have to change in January (although I know I could do that if I had to).

My mother has lived with my family for the last 5 years because of her severe memory issues and needing assistance on day-to-day living (I controlled her bank card and gave her money when she needed it, washed her clothes, cleaned her room, and cooked for her, but she was able to do everything else, even shop in a store by herself. I just had to limit how much money she could take because her memory was getting very poorly).

However, that was before she had a second stroke a few weeks ago. She had to have emergency surgery to open up the arteries going to her brain, but she still cannot walk, cannot stand unassisted, cannot hold anything for herself (to include a pencil or a cup), cannot even talk. She’s a sitting vegetable. When you speak to her, she responds with her emotions and and she can point on a piece of paper to what item/activity she wants to do, but she can’t move or communicate.

The rehab facility wanted me to sign admission paperwork for her yesterday, telling me she can’t do it for herself and this will make me financially responsible for her care there. At first I thought, no big deal, because the last time she had a stroke (much less severe) she received 100 day of inpatient care and rehabilitation and her Medicare with AARP paid 100% of the costs. And she was able to move and talk then, so with this stroke being so much worse, surely she’d receive the same things. But no.

At some point since her last stroke, apparently someone has called her and convinced her to sign up for Medicare Advantage with Humana plan. She still has her AARP supplemental too, but Humana gets to “manage” her care. And according to them, I need to agree to a $218 a DAY co-pay, and she’ll only get 20 days of rehab before they send her home. When I asked what happens if she can’t come home at the end of the 20 days, since last time she needed 100 to even walk from her bed to the shower and now she’s much worse off than before, and the rehab’s financial lady said that’s not even an option for her under this plan. They also said if I do sign for this that they can’t bill her insurance at all and that her costs per day would go up to four hundred and something per day.

HOW did this happen and WHAT do I do? She’s 84 years old! I can’t sign for $218 a day co-pay! It would bankrupt my husband and I! We have a child graduating highschool this year and 2 babies at home. (Yes, as enjoying raising our first, only child, we decided to start over in our 40s.) With a 5 year old autistic daughter who stays home with me and a newborn who is not even a year old, there’s no way I could care for my mother properly at home in just 20 days! And we can’t afford the $218/day co pay anyway! Who could?! But she cant stand, can’t walk even 1 step without a “2-person assist. She can’t hold a cup, or speak anything at all. And she’s crying a lot, understandably because of the frustration of it all. How they can thy demand such absurd amounts of money and then deny her even the basic care she received before they tricked her into signing up for the for-profit company management “help”??!

I’m distraught and at a loss of what to do. Any advice at all would be appreciated.

Me: 65 year old US Citizen signed up for Medicare Part A, will be on Part B in July post retirement (already signed up). Living overseas, moving back to the US in July or August. Will sign up for supplement plan once living in the US (SEP qualifies).

Spouse: 65 year old NON-citizen, expected to obtain green card (LPR) status upon immigration arrival when we move to the US in July or August.

We have been married for more than 10 years.

Once we arrive, I need help signing up for the supplemental, and we especially need help getting my spouse signed up for Medicare A, B, plus supplemental as they should qualify based on my working history and our being married for more than 1 year.

So I will need a broker who is knowledgable not just in the plans available in Connecticut, but in the details of signing up for recent immigrant married long-term to qualifying US citizen who is just moving back to the USA.

Recommendations welcome - thanks in advance!

Note - using a throw-away account since there is so much personal detail.

Be wary of paying your Medicare deductible up front to any medical service provider or medical equipment provider. Panorama Orthopedic and Spine is an orthopedic services provider in Golden, CO. Golden Ridge Asc is the facility in the same building as Panorama. I understand both entities are owned by the physician groups who work there.

In January 2026, Golden Ridge ASC demanded I pay my full $283 deductible at the door prior to receiving service. When I received the Medicare claim copies, Medicare only allotted Golden Ridge $46.04, the balance of $236.96 was allotted to the Panorama doctors who cared for me. Golden Ridge then failed to report my $283 payment to Medicare and refused to share the balance of the funds with the Panorama doctors, resulting in me being double-billed.

I spent two months chasing a refund. Golden Ridge ignored my calls until I filed complaints with the credit card company, the BBB and Medicare Fraud. Medicare told me that I should not pay any provider all of my deductible ever, because only Medicare determines which providers receive Medicare disbursements, and Medicare also determines how much those disbursements are, not the providers themselves. I eventually received a refund for the overcharge, but the stress and lack of communication were unacceptable - very shoddy and predatory billing practices. I will not be returning to Panorama or Golden Ridge for care, and I advise all Medicare patients to wait for their official Medicare Summary Notice (MSN) claims before paying any providers (claims are available online at Medicare in about 6 weeks; paper MSN summaries are now only sent every 6 months). I would also report any providers demanding my deductible up front to your PCP (or referring physicians) and to Medicare.

Been waiting for enrollment approval. Has anyone else waited 4 months?

Just received my Medicare statement. Gpaak Equipments tried to invoice for urinary catheters to the turn of over $10,000. This has been an ongoing fraud - obviously Medicare denied payment. Keep reporting this.

Hi!

I don't know where to start.

My mom quit her job earlier this year and all that I know is that she has Medicare part A.

She was approached by someone to enroll in Humana recently but from what I've read it might not be the greatest?

From what I've read Traditional Medicare is the way to go however its costly? I this a monthly out of pocket plan or deducted from SSA? Is there any plan out there that is similar to TM?

Thank you so Much!

Medicare history question

I am dually eligible (Medicare and Medicaid recipient) and I have been eligible for QMB (Part B) and Extra Help (Part D) since starting Medicare. Extra Help has been seamless, but I just had a surprise, a $1,400 deduction from this month’s social security benefit for unpaid Part B premiums that I thought had been paid by the state of NH. How do I best approach this with NH DHHS? Do I need a lawyer?

Hi,

I'm a California resident with Medicare kicking in May 1st of this year. I was quarterly billed for a little over $600, but my understanding is that if I have medi-cal, that's supposed to be covered. I've had no luck reaching out to my social securtity office and going to the DPSS office. I am currently still working and not collecting social security, but I plan on applying for it next month. Does anyone know where/who I can reach out to regarding this issue? Has anyone faced a similar problem? Any help is appreciated, thank you.

I turn 65 in mid December 2031. My husband turns 65 in mid June 2032. I am currently working and my health insurance covers both of us. We won’t take social security until after age 65. He is not working.

I like my job and am happy to work as long as I need to not to have a gap in health coverage. I don’t want to sign up for an Affordable Care Act plan as we did that a few years ago in between jobs and had to change doctors and it was just a bit of a hassle and if we have any real medical issues at that time I don’t want to deal with it. I am happy to retire before I am 65 and pay for Cobra as that won’t change our coverage.

Relying on Cobra and then moving to Medicare when eligible, how does the timing work? Do I work until December 2030 - which is 18 months before my husband is 65, meaning he will have full Cobra coverage until he is Medicare eligible? If yes, do I still sign up for Medicare in the 3 months before I turn 65 but indicate I’ll have Cobra until June 2032?

I’m not too worried about timing it exactly - happy to work until Jan/Feb 2031 to ensure no gap but can’t seem to find any resources indicating how my employer based coverage/Cobra and Medicare interact when I am the older spouse. Happy to be pointed to some good resources and as we get closer I’m sure we’ll get some actual broker advice.

Thanks for any help with this!

Wife signed up for Medicare this week via SSA.gov & confirmed via a phone appointment with SSA (her IEP is now thru Oct). We thought she was signing up for Parts A and B but the sign up page didn't mention anything about Part A only or Part B, only whether she wanted to signup for both Medicare and Soc Sec, or Medicare alone (she's wanted Medicare only).

Today she got a message from SSA/Medicare saying her Part A coverage starts in July (month she turns 65). It says we have until Oct 1 to sign up for Part B, then says we need to wait for general enrollment period to sign up for B or a special enrollment period if special circumstances apply. Anyway - the language in this message re: Part B is not clear.

The sign up instructions said to have current insurance info available, yet nothing was requested about this insurance either online or in the later phone call - I guess that should have been a clue. We currently have COBRA coverage (i.e., we're not on an employer plan). She logged back on to SSA today to see if there was a separate Part B sign up (based on some other Reddit posts) - the Medicare signup link is no longer available and it says she's signed up for Part A (or maybe just says signed up for Medicare) and includes a reference to call or contact Medicare for Part C and D signup - but no mention of signing up for Part B on the SSA site today.

What's going on with Part B sign up?

My parents have Medigap. Dad is 80. His premiums for F are going from $258 to $294 in 2026 and to $414 in 2027.

Mom is 83 and passed underwriting at 82 and moved to G last year. Her premiums are going from $220 to $263 in 2026 and to $356 in 2027.

These premiums are quickly climbing to a scary level. They are applying for SLMB Medicare savings plan, which should help offset these costs a couple of years because it will give them some more money in the bank. But not sure what to do after that.

If one of them needs in-home aid in the future is switching that parent to elder Medicaid a good option instead?

They are about $100 in monthly income over the limit for QMB Medicare savings plan, which would otherwise act as its own very low cost Medicare supplement.

I have had plan F for 6 years. I started paying $180.00, through the years it does increase understandably. I received a letter of my increase for next month and it’s the highest increase ever. It will be $357. I called and changed to plan N $195.

I know I will have copayment and ER charges but I simply cannot afford to pay that amount and worried that next year this time it will hit the four hundred range per month. If plan N rises to high I will just go with an Advantage plan. I figured give plan N a try and see how it goes.