What's a Medicare rule or regulation that's outdated or unfair to seniors?

Question

Bryan Smith · Accepted Answer

Medicare raises costs for seniors who miss their Part B or Part D signup deadline, even if they didn’t know about it.

Larry Dalton · Answer

This is in relation to the penalties for failing to sign up within the time frames for Medicare Part B or Part D. Missing these dates can significantly cost seniors throughout their remaining lives. It can also affect the choices that you may make on your Medicare Advantage plans. Check with your agent about the timelines and penalties for missing out on signing up.

Answered by Larry Dalton on April 10, 2025

Broker Licensed in OK & TX

Answered by Larry Dalton Medicare Insurance Agent

Nikki Rowland · Answer

Original Medicare lets you see any doctor nationwide and works well for people who travel or want flexibility. It usually costs more monthly, especially if you add drug (Part D) and Medigap coverage, but you’ll have fewer restrictions.

Medicare Advantage is a lower-cost, all-in-one option from private insurers that includes extras like dental and vision. It often has network limits and copays, but can save you money if you’re okay with those trade-offs.

Andrew Zurbuch, MBA · Answer

When a American Citizen whom comes off of C.O.B.R.A. there is no guarantee issue right into a Medigap Insurance plan. C.O.B.R.A. can last 18 months or 36 months. Medigap Insurance means the same as Medicare Supplement Insurance. Therefore, their application for Medigap Insurance may be denied.

Answered by Andrew Zurbuch, MBA on April 30, 2025

Broker Licensed in IN, FL, KY, MO, OH & TN

Answered by Andrew Zurbuch, MBA Medicare Insurance Agent

Deb Haley · Answer

One Medicare rule that is outdated and unfair is when someone is first eligible for Medicare and are allowed to enroll in just part A and they continue to work and contribute to an HSA account, once they enroll in Part A they are no longer allowed to contribute pre-tax dollars to their HSA account. They may also be subject to a penalty if they did not stop contributing to the HSA account 6 months prior to retirement. This is outdated and unfair to seniors who continue to work because most people these days do not plan their retirement 6 months in advance.

Answered by Deb Haley on May 28, 2025

Broker Licensed in MA, CT, FL & 10 other states

Answered by Deb Haley Medicare Insurance Agent

Fred Manas · Answer

One outdated and potentially unfair Medicare regulation is the "Improvement Standard" that some argue inappropriately limits coverage for skilled nursing home care when no improvement is expected. This standard suggests that Medicare may not cover care for conditions where no improvement is possible, even if the care is essential for maintaining or preventing deterioration. Here's why this is a problem: 
Focus on "improvement" over maintenance:  The standard focuses on whether a patient can improve, rather than whether they require skilled care to prevent or slow decline, according to the Center for Medicare Advocacy.
Limited access to necessary care:  This can deny individuals the care they need to manage chronic conditions and maintain their quality of life, notes the Center for Medicare Advocacy.
Disproportionate impact:  This can disproportionately affect individuals with progressive illnesses or those who are near the end of life, notes the Center for Medicare Advocacy.
While the Medicare program acknowledges the need for skilled care for maintenance purposes, some argue that the "Improvement Standard" interpretation by some providers or insurers may not fully reflect this principle.

Robert Baez · Answer

Medicare raises costs for seniors who miss their Part B or Part D signup deadline, even if they didn’t know about it.

Answered by Bryan Smith on March 10, 2025

Broker Licensed in UT, AL, AR & 35 other states

Answered by Bryan Smith Medicare Insurance Agent

Chuck Winslow · Answer

One rule I think is pretty outdated—and honestly not fair to seniors—is the 3-day hospital stay requirement for Medicare to cover rehab or skilled nursing care. A lot of folks don’t realize that if you’re in the hospital under “observation” instead of being officially admitted for three full days, Medicare won’t help with the nursing home costs after. Even if you’re lying in a hospital bed for days, it might not count. It’s confusing, and it ends up costing seniors way more than it should.

Answered by Chuck Winslow on April 30, 2025

Agent Licensed in IN

Answered by Chuck Winslow Medicare Insurance Agent

Todd Bostic · Answer

That would be the "Donut Hole" as most people refer to it. I was on Medicare for 17 years, and I would ultimately hit it every year around August, but I noticed that it started to get earlier and earlier every year. However, starting in 2025, it was eliminated, and there isn't a "Donut Hole" anymore.

Answered by Todd Bostic on May 28, 2025

Broker Licensed in TX, AL, AZ & 12 other states

Answered by Todd Bostic Medicare Insurance Agent

Patrick Stinson · Answer

I would say the three-night hospital stay required for nursing home benefits. It states that an individual must stay in the hospital for 3 consecutive nights to be eligable for Medicare coverage at a skilled nursing facility.

Answered by Patrick Stinson on April 30, 2025

Broker Licensed in TX, AR, AZ & 9 other states

Answered by Patrick Stinson Medicare Insurance Agent

Chris Prang · Answer

The 3-day hospital stay to have skilled nursing covered by Medicare and your Medicare Supplement. If you have Medicare Advantage, there's no 3-day rule thankfully.

The silly marketing rules for agents...like the Scope of Appointment and call recorded line. Both are childish and don't stop the bad agents. They only make it harder and less efficient for the good agents and Medicare beneficiaries. 

I hope that helps.

Chris

Tommy Lawson · Answer

The biggest thing that comes to mind is the late enrollment penalties for Part B and Part D.  It's not a flat penalty, but it accumulates over time.

What's a Medicare rule or regulation that's outdated or unfair to seniors?

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What's a Medicare rule or regulation that's outdated or unfair to seniors?

Agents: Share Your Expertise

Seniors: Ask a Question of Your Own

Related Questions

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Medicare Agents HubA non-government resource website

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A non-government resource website