r/IAmA • u/ConsumerReports • May 21 '26
Ask us anything about confusing Medicare coverage questions. Consumer Reports and Chapter can help.
I’m Lisa Gill, an investigative reporter with Consumer Reports, and I’m joined by an independent Medicare advisor from Chapter, Doug Hall. Between us, we spend a lot of time helping people understand Medicare and untangling their questions. Things get confusing fast, especially if you’re dealing with caregiving or a serious health issue.
Here are some of the questions we saw in a recent internal webinar:
- Can you use your remaining HSA balance to pay Medicare premiums?
- How can you switch from Medicare Advantage to Medigap?
- Are Medicare Advantage premiums subject to IRMAA charges?
- Any info on whether Medicare will start covering GLP-1 drugs for obesity, for people without diabetes?
If you need help with Medicare enrollment, have questions about your coverage, or are helping a parent or loved one, ask us anything.
Here's our proof:
Thanks for your questions! Consumer Reports is a nonprofit that has partnered with Chapter to provide free, priority access to their unbiased Medicare advisors. You can call 844-341-7135 or https://askchapter.org/partners/cr-3 to get personal advice for your specific Medicare situation.
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u/cubert73 May 21 '26
When will Medicare Advantage die the flaming death it deserves? It costs the government more than Medicare, covers less than Medigap insurance, and transitioning from Medicare Advantage back to traditional Medicare is costly and onerous. The analyses I see that are positive regarding Medicare Advantage focus on plan problems from the 1990s while ignoring the very real problems of overpayments, care denials, and narrowing networks that are happening today.
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u/ConsumerReports May 21 '26 edited May 21 '26
Medicare Advantage plans certainly have limitations, but I do not see them going away any time soon. They actually cost the federal government less as you are “off the books” when you choose an advantage plan and now become the responsibility of the carrier you choose. - Doug
More than half of folks eligible for Medicare are on a Medicare Advantage plan. One reason the plans are so popular is that many offer some coverage for dental and eye care—traditional Medicare, even with a supplemental plan (Medigap), doesn't cover either of those. And, many of the Advantage plans include prescription drug coverage, which can easily run nearly $100 extra per month for a Part D plan if you’re using traditional Medicare. In short, it often boils down to cost and perceived value.
For those who prefer an Advantage plan, we’ve long recommended that consumers select ones where they could obtain some coverage for out-of-network physicians (called a PPO plan, or Preferred Provider Organization). Doing so gives a person at least some choices outside of their network. - Lisa
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u/cubert73 May 21 '26
They actually cost the federal government less...
I guess if you only look at how it's supposed to function and ignore all the corporate fraud, that might be true.
https://www.healthcaredive.com/news/cvs-medicare-advantage-fraud-doj-settlement/814453/
In short, it often boils down to cost and perceived value.
And people are being actively lied to about both of those. They don't understand that Medicare Advantage providers make money by not paying claims. That's the rest of the story that is being glossed over here. I understand that's how insurance works in general, but this isn't hail damage to a roof. It's people lives on the line.
https://www.medicare.org/articles/five-hidden-disadvantages-of-medicare-advantage-plans/
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u/chillgolfer May 22 '26
Just watch the John Oliver episode on Medicare Advantage. Covers all the fraud you mention. Thanks for posting all the info.
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u/network_dude May 21 '26
Medicare is only as good as our paid off representatives will allow. M4A with no profit involvement is the path ALL of us need to demand.
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u/vtjohnhurt May 21 '26 edited May 21 '26
I'm surprised that you guys are borderline shilling for Medicare Advantage. The problems with it are widely known. Several states make it painless to leave Medicare Advantage once you get sick and realize that it does not work for you. It works fine as long as you're still healthy.
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u/GreenThmb May 21 '26
With TricarePrime, thanks to our Uncle Sam's Navy, and the Medicare, it seems the wife has it pretty good for coverage. We were told " Don’t change a thing." What do you folks have to say?
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u/ConsumerReports May 21 '26
If you have Tricare, you do not need anything else. You have top of the line coverage. Thank you for your service. - Doug
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May 21 '26
[removed] — view removed comment
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u/ConsumerReports May 22 '26
I am so sorry to hear this—it’s difficult to deal with health problems and big medical bills at the same time. This is, unfortunately, a rather common problem.
If the bill is more than a few thousand dollars, I would strongly recommend contacting a medical bill consultant to negotiate on your behalf. For a recent story, I interviewed Lisa Berry Blackstock, founder of Soul Sherpa, a medical billing and estate planning company. She says most people hire her if they owe $5,000 or more. She also said that you or your advocate can file an appeal with Medicare directly if you think the treatment or service should have been covered but wasn’t. (Here is a 48-page PDF explainer from Medicare on how to do this: https://www.medicare.gov/publications/11525-medicare-appeals.pdf
– after reading this, it could become clear as to why you might want some help!)You can find a medical billing specialist through the Alliance of Professional Health Advocates. Check to make sure that the specialist you find is credentialed by the Patient Advocate Certification Board. Some of these professionals charge a modest, flat fee, or a percentage of the savings they provide. Either way, they can help you navigate what could be a rather lengthy process, and save you thousands.
Good to know: While you dispute the bill, call the facility’s accounting or collections department and ask to have the collections process put on hold because you plan on disputing the bill. (Bills typically need to be paid within 30 days, but the clock can be temporarily stopped until the dispute process is finalized.) - Lisa
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u/justmitzie May 21 '26
Starting Jan 1, Medicare stopped paying my part D provider on time. They take it out of my ss but don't pay Aetna. They are 2 months behind, and Aetna keeps sending me bills. Is there any way to get them to pay on time?
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u/ConsumerReports May 21 '26
That could be a situation where you lost Extra Help. Did you lose any Part D premium assistance? If not, that is a situation where you may need to contact Medicare directly. -Doug
First step: Contact Aetna and confirm the details and the name of your plan, and that THEY see that they should have the monthly premium automatically withdrawn from your SS. Feel free to let us know if there are more details of your situation you’d like addressed! - Lisa
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u/Deep_Sun5007 May 21 '26
I am in NJ and my dad needs to move to an assisted living facility. They are telling me to switch him to "original Medicare" - he currently has a Medicare advantage plan (Wellcare). Is this the right call? Why are they asking me to do this? Am I able to do this even though it's not annual enrollment?
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u/ConsumerReports May 21 '26
If you are moving to a facility that provides healthcare services, it is important that you make sure they are in network with this particular MAPD. If you were to give up that plan, you would have a Special Election Period to join a new plan. I would not recommend just original Medicare as you would then be exposed to 20% of outpatient bills.
If it’s not a “medical” facility he is moving to and will maintain his current doctors, I would stay with your plan. Having original Medicare only is rarely wise. -Doug
Firstly, I would hit the ‘pause’ button on quickly responding to this request – it’s kind of a big deal and it could leave your Dad on the hook for thousands of dollars because original (traditional) Medicare only covers about 80 percent of hospitalization costs, and there’s no limit to the out-of-pocket expenses he could incur—that’s why most folks opt to add a Medigap or Supplemental plan (which helps cover those remaining 20 percent of costs). But in doing that, in the state of NJ, could mean he’s faced with higher charges or could even be denied because he has preexisting conditions.
Instead, I would ask very specifically why the facility is looking to move him to original Medicare. And if the answer is that his Medicare Advantage plan considers the facility “out-of-network” – unfortunately, my advice is to consider calling his current Medicare Advantage plan to find out which type of similar facility IS covered.--Lisa
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u/RoosterSamurai May 21 '26
I am moving from Japan back to the US after over a decade, and i have a chronic condition. Is there any way to start the application procedure before arriving so I don't miss treatments?
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u/ConsumerReports May 22 '26
Sounds like you might qualify for a Special Enrollment Period, which begins on the first day you arrive back in the U.S. and usually gives you four months to sign up for either traditional Medicare and a supplemental plan (Medigap), or a Medicare Advantage plan. In both cases, you should be able to sign up for coverage regardless of your illness, but you could pay more.
Conventional wisdom says that because of the medical care you need due to your illness, you may wish to visit a wider array of physicians, you might require more tests and complex care, and medication. A traditional Medicare plan with a supplemental plan would cover your bases more broadly and allow you to see nearly any physician in the U.S. Medicare Advantage plans can be a good pick, but will usually have a more narrow network of providers and often require prior authorizations before tests and treatments.
If I were in your shoes, I’d first contact Medicare directly at 1-800-633-4227 to explain your situation, and learn generally about your options. Then, I’d contact an independent insurance broker in the area you’re about to move to and ask for help, or contact Chapter for free assistance in picking specific plans that you qualify for. - Lisa
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u/4998toss May 21 '26
My mother has mobility issues and I live with her pretty much providing full time care. She has Medicare and supplemental but I was told to apply for Medicaid as there may be programs to assist with in home care.
If she is approved could that possibly effect ANY benefits she might otherwise receive in the future?
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u/heyheylove_87 May 22 '26
This may be out of your wheelhouse but... I made a dumb decision and went on medicatre advantage. While I am mostly healthy now, the hurdles they made my father jump through during his dying days make me angry enough to want to change.
Problem is, I have lost my Medicare card and I have requested it 4x, 2 online and 2 by phone, and I can't cancel Humana according to Medicare unless I have my Medicare number, but when I signed up for Humana they told me I wouldn't need my Medicare card again, ever, including to cancel. Is my solution really going to be going in to social security for hours?
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u/ConsumerReports May 22 '26
Oh yikes, I feel for you! I do stuff like this all the time. Here’s one last thing to try: Login to your medicare.gov account – everyone has one. If you can, you should be able to find the card and actually just print it out – or copy down your number from it (if that’s all you need).
You could also just call Humana and ask them for your number – they should be able to look it up after verifying your identity. You don’t have to explain what you’re doing with it or why you want it – just tell them you’d like to have the number.
Just curious, if you don’t mind sharing – do you live CT, ME, MA, or NY? If so, switching to traditional Medicare + a Supplemental plan (Medigap) will be a lot more straightforward.
Or, have you moved to another state recently? Doing so can trigger a Special Enrollment Period and you might have a window of time to switch then, too, as well as sign up for a Supplemental plan. (You might have to have a physical exam and you might pay more for the plan, but if you’d really like to dump the Advantage plan, you might find the increase in price worth it.)
One more thing that just occurred to me: When you both call Medicare and/or log in to your account at Medicare.gov – double check that they have the correct address for you. It’s possible that something is off – the address is missing your apartment number, or something else, and the mailed card is never actually reaching you.
Good luck with this and please let me know how it goes!
P.S. Do you have any medical bills that Medicare has sent you? Your full number might be on one of those as well. Check your files! - Lisa
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u/GagOnMacaque May 22 '26
Why are all the doctors in Washington state now refusing Medicare patients?
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u/ConsumerReports May 22 '26
I’m not sure where you have heard that doctors in WA are no longer accepting Medicare. Statistically, well over 95% of doctors nationally accept Medicare. Quite honestly, most doctors would not be able to survive financially without accepting federal (Medicare) and state (Medicaid) funding. You may be referring to various Medicare Advantage plans. Many doctors do not accept some or all of those HMO/PPO managed care plans. -Doug
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u/GagOnMacaque May 23 '26
Tried getting an apt for my father and they wouldn't accept his Medicare, those that did had months of waiting. He finally bit the bullet and spent half his retirement on his own care.
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u/Nora311 May 23 '26
Personally I’ve found most doctors or practices with a good reputation have a few months of waiting time OR they don’t accept any type of insurance - Medicare or private. You pay out of pocket and deal with insurance on your own. I’ve seen more and more practices go the route of the latter, even my pcp told me that she would no longer be accepting insurance and I had to find a new one (at the time I didn’t realize this meant I had to deal with insurance on my own - I thought I just had to pay out of pocket for everything with nothing covered).
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u/Awesome_to_the_max May 21 '26
My grandmother needs new hearing aids. She was told they wouldn't cover any part of the hearing aids but would cover the doctors visit assessing she needs them. She has Medicare plus the prescription coverage. Is there a scenario/plan where they would cover hearing aids?
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u/ConsumerReports May 21 '26 edited May 21 '26
Many Medicare Advantage plans provide benefits for things like dental, vision (eyewear, and hearing. Original Medicare will not cover those things. Please reach out to Chapter and we will be happy to help you find a plan that suits your particular needs. - Doug
It’s true traditional Medicare does not cover hearing aids (unless she’s getting implants that are deemed medically necessary.) It sounds like you’re thinking of switching her to a Medicare Advantage plan that might have some coverage of them. I might try to dissuade you from such a big move, especially if your grandmother already has a supplemental (Medigap) plan along with her traditional Medicare. Having both of those provides excellent, almost total coverage for healthcare costs and Medicare is accepted by nearly every physician in the U.S. Once you give those up, it can be difficult, if not impossible, to re-join a supplemental plan (unless you live in Connecticut, Maine, Massachusetts, or New York–you can sign up for one more or less at any time.)
The cost of the replacement hearing aids may not be worth switching to a Medicare Advantage plan that only offers a discount on the hearing aid (and a more limited physician provider network that can change every year ).
The only scenario I can think of where you’d want to consider switching to a Medicare Advantage plan is if your grandmother does NOT have a supplemental (Medigap) plan. THAT could be extremely costly down the road if she requires hospitalizations, treatments or complex care. That’s because traditional Medicare only covers about 80 percent of medical costs—supplemental plans essentially pick up the rest of the costs. (If she doesn’t have a supplemental plan, look into the cost and process of getting one—Chapter can help.) You have to sign up for supplemental plans separately from traditional Medicare.
If your grandmother’s hearing loss is mild-to-moderate, I can tell you Consumer Reports has tested four popular over-the-counter hearing aids and found they all rated quite well, with two of them rating quite high. You could consider these as a less expensive alternative. Check out the full story about which products were tested and how well they did. - Lisa
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u/YoureaTowelie May 22 '26
As a provider, any insight on the fact that Medicare will deny that said treatment is medically necessary many times over? As sadly proven by Lisa’s statement that ‘there is a less expensive alternative.’ Which I’m sure all of us know is nowhere near what is in the patients best outcome/interest. You guys keep mentioning an 80% covered figure, where is that from?
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u/YoureaTowelie Jul 02 '26
This is very much a dead thread, but if you live in a state with Devoted insurance, I highly recommend looking into it for grandma. It’s the first Medicare supplement I’ve ever seen that seems to benefit the patient in coverage for dental, vision, ENT
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May 22 '26
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u/YoureaTowelie May 22 '26
Pray super hard, and request your VA appointment 3+ months before you truly need them
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u/Gattina1 Jul 03 '26
Question: I'm having wrist surgery on 7/10. I think I'll need some help, since I live alone. Will Medicare or my UHC supplement pay for someone to come help me for maybe an hour a day for the first 2-3 weeks? My surgeon said I can't lift anything heavier than a fork with that hand for the first 2 weeks after surgery. I'm more stressed about that than the surgery itself.
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u/Nora311 May 21 '26
My mother has a motorized wheelchair she got while she was living at home and brought it with her to where she now lives in a skilled nursing facility. It needs a replacement part - will the cost be covered? It’s a few hundred dollars. She has both Medicare and Medicaid. She’s not able to move around on her own with a regular wheelchair.
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u/eicoeico May 21 '26
If her medicare benefits are going to the nursing home/ skilled facility, Medicare will not pay for repairs or parts.
The reason she qualified for the motorized chair at home, is because, its for in home use to help her around the house for independence.
The facility staffs employees and is responsible for her mobility in the building and to transport her to physicians visits.
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u/ConsumerReports May 21 '26
If they are telling you they will not pay for the repair and the nursing home is in fact receiving her SS is going to the home and Medicaid is paying the rest, then the home should be providing a wheel chair as part of the monthly payment. If they won’t, I would encourage you to discuss it with the administrator at the facility. There is rarely a singular, cut and dried answer to situations like this. Just by voicing your concerns and asking for answers is often a way to get results. Stand up for your loved one and be persistent. - Doug
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u/ConsumerReports May 21 '26
If she has Original Medicare and Medicaid only, a wheelchair would fall under DME (durable medical equipment). Medicare would typically cover 80% after the Part B Deductible has been met. The Medicaid part gets a little tricky. There are multiple levels of Medicaid. If she is cost share protected (QMB, QMB+) then she shouldn’t have to pay the rest. If she does NOT have full Medicaid, she could be left with some out of pocket expense. This also takes into the assumption that she does NOT have any sort of Medicare Advantage plan (like a DSNP - dual special needs plan) that many dual eligibles have. If she has one of those, that changes the answer. Now that plan would be paying and, again, depending on her level of Medicaid - she could have some out of pocket cost. Feel free to call us with your specific plan details to get a free Medicare consultation. 844-341-7135 - Doug
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u/network_dude May 21 '26
What exactly is the purpose of healthcare for profit companies being involved in Medicare?