February is the “Month of Discovery” for Medicare beneficiaries. In January, you visited the doctor, picked up prescriptions, and perhaps had a minor procedure under your new 2026 coverage. Now, in February, the Explanation of Benefits (EOB) and Medicare Summary Notices (MSN) are arriving in the mail.
In 2026, these statements look different than in previous years. The implementation of the Inflation Reduction Act’s $2,000 Part D cap and the new Medicare Prescription Payment Plan (M3P) has altered the flow of money between pharmacies, insurers, and patients. This transition has created a fertile ground for billing errors. Algorithms are misapplying deductibles, and new “prior authorization” bots are denying care that should be covered. Before you write a check for that balance due, check your statement for these six specific errors that seniors are catching right now.
1. The “Smoothed” Pharmacy Bill Confusion
The biggest change in 2026 is the option to “smooth” your drug costs—spreading your out-of-pocket expenses over the year rather than paying them all at the pharmacy counter. If you opted into the Medicare Prescription Payment Plan, you should pay $0 at the pharmacy and receive a separate monthly bill from your insurer.
The Error: Many seniors are reporting “double billing” confusion in February. They paid a co-pay at the pharmacy (because the system hadn’t updated their opt-in status yet) but also received a monthly bill from their plan for the same drug. Or, they are receiving a bill for the full deductible amount when it should have been amortized over 12 months. If you are in the M3P program, compare your pharmacy receipt against your plan’s monthly invoice carefully. You should not be paying both.
2. The “Observation Status” Hangover
For years, seniors have battled the distinction between being “admitted” to a hospital versus being under “observation.” If you are under observation, you are an outpatient, meaning Medicare Part A (hospital) doesn’t pay, and—crucially—you don’t qualify for covered rehab in a skilled nursing facility.
The Error: A critical deadline just passed on January 2, 2026, for filing retrospective appeals for observation stays dating back to 2009. However, for current 2026 stays, hospitals are still defaulting patients to “Observation” to avoid readmission penalties. If your February bill shows hourly charges for a hospital room but lists you as an outpatient, you are likely being billed for self-pay rehab or excessive Part B co-pays. You have the right to appeal this status while still in the hospital, but it is much harder once the bill arrives.
3. The “Wellness” Turncoat
Your “Annual Wellness Visit” is free under Medicare, with no co-pay and no deductible. It is a conversation about your health, not a physical exam.
The Error: This is the most common February surprise. You went in for your free wellness visit in January, but you mentioned your back hurt. The doctor asked a few questions and looked at your back. That simple interaction converted the visit from “Preventive” (Code G0438) to “Diagnostic” (Code 99213 or similar). Suddenly, you have a bill for $150 because the visit is now subject to your Part B deductible. If the bulk of the visit was counseling, you can ask the billing office to resubmit the claim with the correct preventive modifier.
4. The “Ghost Network” Denial
Medicare Advantage (MA) plans change their provider networks every January 1st. Doctors who were “In-Network” in December 2025 may have dropped the plan for 2026 due to contract disputes.
The Error: You visited your regular cardiologist in January, assuming they were still covered. In February, you get a bill for the full “Out-of-Network” price because the doctor left the network and you weren’t notified (or missed the letter). While the No Surprises Act protects you in emergencies, it offers less protection for scheduled visits. If the plan’s online directory still listed the doctor as active when you visited, you can appeal the bill based on “directory inaccuracy.”
5. The “AI” Rehab Cutoff
In 2026, Medicare Advantage plans are increasingly using Artificial Intelligence (AI) algorithms to predict how long a patient should stay in physical therapy or a nursing home, often cutting coverage off earlier than a human doctor would.
The Error: You receive a “Notice of Medicare Non-Coverage” saying your therapy is ending because you have “plateaued,” even though your doctor says you need more time. This is often an algorithmic denial, not a medical one. If you receive a bill for therapy sessions in February that the plan refused to cover, you must appeal by citing the recent CMS rules that restrict the use of AI in making coverage denials without human oversight.
6. The “Excess Charge” Ambush
If you have Original Medicare (not Advantage) and see a doctor who does not “accept assignment,” they can legally charge you 15% more than the Medicare-approved amount. This is called a “Part B Excess Charge.”
The Error: Many seniors switched to new specialists in January. If you live in a state that allows excess charges (some states like NY, MA, and PA ban them), your February bill might be 15% higher than expected. This is not a “mistake” in the coding sense, but it is often a surprise to patients who assumed all doctors accept Medicare rates. Check the “limiting charge” line on your statement to see if you are paying this premium.
Don’t Pay Until You Verify
If the numbers on your February statement don’t look right, do not just pay them to make the headache go away. Call the provider’s billing office first, then 1-800-MEDICARE or your SHIP (State Health Insurance Assistance Program) counselor. In 2026, the systems are new, and the “glitches” are expensive.
Did you get a bill for a prescription you thought was covered? Leave a comment below—tell us if you are using the new payment plan!
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