Is There A Difference Between A Medicare Complaint And An Appeal
Yes, and its important to know which issue youre addressing before you contact Medicare. A complaint deals with things such as:
- You have a problem with how your doctor treated you.
- You arent happy with the quality of your care.
- You believe a hospital or other facility treated you unfairly.
- You arent satisfied with the quality of your durable medical equipment.
- Your plans customer service department was unable to answer your questions.
An appeal, on the other hand, deals specifically with your plans refusal to pay for services, durable medical equipment, or prescription medications. This article discusses how to contact Medicare to file a complaint if you want to file an appeal, the process is a bit different.
How Do I Contact Medicare To File A Complaint About Durable Medical Equipment
If you have a complaint with your Medicare DME, your first step is to contact your DME supplier. The supplier has five days to let you know they have received your complaint, and 14 days to report the results of any investigation into the issue.
You should also contact Medicare at 1-800-MEDICARE and report the issue. TTY users should call 1-877-486-2048. If the supplier doesnt resolve it to your satisfaction, you may be able to file an appeal or take additional action against the supplier.
What Is The Part B Premium Reduction Benefit
When you’re enrolled in Medicare Part B, you must pay a monthly premium of $170.10. The giveback benefit, or Part B premium reduction, is when the Part C Medicare Advantage plan reduces the amount you pay toward that premium. Your reduction could range from less than $1 to the full premium amount.
Even though you’re paying less for the monthly premium, you don’t technically get money back. Instead, you just pay the reduced amount and are saving the amount you’d normally pay.
If your premium comes out of your Social Security check, your payment will reflect the lower amount. If you don’t pay that way, the giveback benefit would be credited to your monthly statement. Instead of paying the full $148.50, you’d only pay the amount with the giveback benefit included.
For example, if you typically pay $170.10 per month but your MA plan’s giveback benefit is $50, you don’t get $50 back each month. Instead, you’d only pay $120.10 per month, keeping that $50 in your wallet. If your plan offers a full $170.10 refund, you wouldn’t have a Part B monthly premium to pay.
Also Check: Can You Get Medicare Insurance At 62
Who Do I Contact If My Medicare Plan Has Incorrect Information About Me
If your Medicare Advantage or Part D plan has inaccurate information about you , you should contact Social Security to update that information. You will also want to reach out to your insurer to make sure they are aware so that you do not miss out an any correspondence while waiting for Social Security to update their information.
Likewise, if your plan is having a problem with billing or premium payments, you should call Social Security, and also contact your insurer to ask how you can help them update their information. Your insurer may be able to notate your account with the correct information while Medicare processes your updates.
You should also contact the insurer to change how you pay for your coverage, such as establishing direct debit from a bank account or allowing premiums to be deducted from your Social Security benefits.
I Need To Change Doctors What Do I Do
Depending on what type of coverage you have, changing doctors under Medicare will require different steps:
- If you have Original Medicare, Part A and Part B: With this coverage, you can go to any doctor who accepts Medicare patients. You can use the Physician Compare tool at Medicare.gov to help you find a doctor who accepts Medicare assignment.Its a good idea to call the doctors office and verify that he or she will accept new Medicare patients before you make an appointment.
Article Source: Medicare.com
If you have any questions about this subject or would like to speak to us about any of your Medicare needs in regards to Medicare supplement, Medicare Advantage or Part D prescription drug plans, I would certainly be very happy to speak with you.
I am an independent agent specializing in the senior market. My services to you will always be FREE. I would be very happy to look at your current coverage and compare it to the marketplace to make sure that you are still getting a good value.
Also Check: How To Opt Back Into Medicare
Does Medicare Call Your Home
Spammers found a niche in claiming to be Medicare, so if you get a call from a person saying theyre with Medicare, you can guarantee its spam. You may also find that youll start getting spammy emails in your inbox if it sounds suspicious, it more than likely is! Please do not reply to any emails seeking personal information, and be sure to report it as spam immediately. You should never share your Medicare Identifier or Social Security number with a stranger.
If you get calls from someone claiming to be Medicare, get a name and phone number, and call Medicare to make a report.
When Should I File A Medicare Change Of Address
Whenever you need health care as a Medicare beneficiary, your health-care provider, hospital, or medical supplier will ask to see your Medicare card to verify your benefits. If your card gets lost or stolen, its important to have a current address on file with the Social Security Administration so you can get a replacement Medicare card as quickly as possible.
If you know your address is about to change, you can file a Medicare change of address as soon as you have an address and effective date. Even if you file a change of address form with the post office, its still a good idea to complete a Medicare change of address with Social Security to prevent any delays in receiving important notices and information related to your benefits.
If you have questions about your coverage and Medicare change of address procedures, Im happy to assist you in any way I can. Click one of the links below to schedule a phone call or request an email with information prepared just for you. You can even find out about plans in your area by clicking on the Compare Plans button below.
New To Medicare?
Becoming eligible for Medicare can be daunting. But don’t worry, we’re here to help you understand Medicare in 15 minutes or less.
Recommended Reading: Does Humana Offer A Medicare Supplement Plan
Improve Medicare For All Beneficiaries
Medicare is extremely popular, but it needs attention to ensure all beneficiaries receive comprehensive coverage and equitable treatment. The Medicare program that Americans know and cherish has been allowed to wither. Traditional Medicare, preferred by most beneficiaries, has not been improved in years, yet private Medicare Advantage plans have been repeatedly bolstered. Its time to build a better Medicare for all those who rely on it now, and will in the future.
How Do I Cancel My Medicare Coverage
Its usually not a good idea to cancel your Medicare Advantage or Part D plan without having coverage to replace it. This could cause you to face large out-of-pocket expenses.
If you dont have other coverage, and youre struggling to afford your plans premiums, your insurer might agree to payment arrangement. And if youre struggling to afford Medicares premiums, help is often available through a Medicare Savings Program.
You also shouldnt leave your Part D plan if you dont have replacement coverage that is creditable. This means coverage that is at least as comprehensive as Medicare prescription drug benefits. If your new coverage isnt creditable, youll owe a premium penalty if you sign up for Part D in the future.
But you are allowed to disenroll from Part D coverage anytime if youre replacing it with creditable coverage. This rule also allows you to leave a Medicare Advantage plan that includes prescription drug benefits.
If youre certain you want to cancel your Medicare Advantage or Part D plan and are eligible to make changes, you can ask your insurer to disenroll you
The date your plan ends depends on the enrollment period you use. For example, if you disenrolled during fall open enrollment, your enrollment would end December 31.
Also Check: Does Medicare Part D Cover Shingrix
Contacts For Medicare Advantage Medigap And Part D Plans
The Medicare customer service helpline may not have all the answers for Medicare Advantage, Medigap or Part D prescription drug plans. These plans are sold by private insurance companies under contract with Medicare.
You should look for contact information about your plans provider on the card you received from the insurer. Or you may need to look at the information you received about the plan when you first enrolled.
Who Should I Contact If I Have A Problem Enrolling In Medicare Advantage Or Part D
Most beneficiaries dont have trouble enrolling in Medicare Advantage or Part D coverage. But enrollment problems can occur if you provided information while signing up that doesnt match whats in Medicares system. For example, problems could occur if you misspelled your name or inverted digits in your Social Security number. You can usually fix those issues by contacting the insurer or a broker .
Enrollment problems can also happen if Medicare has incorrect information about you on file. If you suspect that might be the case, contact the Social Security Administration at 1-800-772-1213 and make sure your name, birthdate and address are accurate in Social Securitys system.
Insurers can only enroll you in their Medicare Advantage or Part D plan if youre currently eligible to sign up. Youre allowed to enroll only at certain times, such as when you first qualify for Medicare, during the general enrollment period, fall open enrollment, Medicare Advantage open enrollment, or a special enrollment period . If you arent within one of those windows, you wont be able to sign up for a plan now.
Medicare will decide whether or not youre eligible for a SEP based on your circumstances. Unfortunately, you wont be able to appeal if Medicare denies your request. But you could resubmit your request if Medicares decision was incorrect .
Also Check: Does Medicare Cover Skin Removal
You Have Health Insurance You Want To Keep
If you currently have a health insurance plan that you love either through a job, your spouse, a union, or other source you may wish to continue your current coverage.
Deferring Medicare may save you money on monthly premiums, especially if youre a high-wage earner. If your current insurance is provided through a large group insurer and covers everything that Medicare parts B and D cover, you wont be hit with a penalty if you defer for this reason.
What Is The Medicare Phone Number
Any time you have questions concerning your Medicare insurance coverage, you can use the various tools that the Centers for Medicare & Medicare Services and the Social Security Administration have put in place for your assistance.
You can speak to a Medicare representative by calling their official toll-free phone number directly at 1-800-633-4227 . For people who have hearing or speech impairments the number to call is 1-877-468-2048, also listed as the TTY number.
You can speak to a representative at the Social Security Administration to make an appointment with an agent at your local Social Security office by phoning their official toll-free number 1-800-772-1213.
You can also go to the website Medicare.gov which may provide you with information you need on a topic concerning your Medicare coverage.
If you have questions that only a live Medicare representative can help you with, you should have the details about how to contact them.
How do you speak to a Medicare representative live?While you can visit Medicares official online site at Medicare.gov to learn about some issues, there may be instances when you need to speak to an actual human in real time. You can make your call to Medicare by dialing 1-800-633-4227 which is their national helpline. The TTY number is 1-877-486-2048.
The customer service menu for the Medicare helpline is below. You can either say the word you need or press the corresponding number on your dial pad.
Don’t Miss: How Do I Get A Lift Chair Through Medicare
How To Find Important Information About Medicare
If youre looking to find important information about your Medicare coverage, the Medicare hotline might not always have the answers youre looking for.
If you have Medicare Advantage, Medigap, or Medicare Part D prescription coverage, you may have to go directly to those private insurance providers for answers to your questions.
You Currently Have Tricare Or Champva Coverage
Active duty and retired military members and their families are typically eligible for TRICARE health insurance through the Department of Defense. Those who arent eligible, such as surviving spouses and children, may be eligible for CHAMPVA coverage.
If you have TRICARE or CHAMPVA coverage and are eligible for premium-free Part A, you must also enroll in Part B to keep your current coverage.
If you arent eligible for premium-free Part A, youre not required to sign up for Part A or Part B. If you dont sign up during initial enrollment, though, you will incur a lifetime late enrollment penalty whenever you do sign up.
If you want to defer Medicare coverage, you dont need to inform Medicare. Its simple: Just dont sign up when you become eligible.
You can also sign up for Part A but not Part B during initial enrollment.
Recommended Reading: Does Medicare Offer Dental Plans
Can I Call Medicare For Help With My Coverage
You can call Medicare anytime for help with your coverage. The number to call is 1-800-MEDICARE . The TTY number is 1-877-486-2048.
This phone number is meant to be a general resource for questions you have about your Medicare coverage. You can check the status of your claims, inquire about your premium and deductible costs, and more.
Here are other important phone numbers for issues relating to Medicare benefits:
- Centers for Medicaid and Medicare Services can provide information about upcoming Medicaid events, such as health fairs and seminars. The telephone number for their national office is 1-800-772-1213.
- The Department of Veteran Affairs can give you information about how your military benefits work with Medicare. Their nationwide phone number is 1- 827-1000.
- Your State Health Insurance Assistance Program can give you personalized counseling as you choose the Medicare and health insurance options that are right for you. These programs give advice based specifically on the state in which you live. The SHIP national hotline is 1–701-0501.
- To report a lost Medicare card or if you are trying to change your address with Medicare, you may need to call the Social Security Administration office. Their national hotline is 1 772-1213.
How Do I Contact Medicare To File A Complaint Against My Doctor Or Hospital
Complaints against a health care provider fall into four basic categories:
- Complaints of abuse or unsafe conditions,
- Complaints about physical hospital conditions such as poor housekeeping or lack of heat or air conditioning,
- Complaints about unprofessional conduct, or
- Complaints about your quality of care, such as prescription drug errors, unnecessary procedures, or poor discharge planning and follow up care.
The first three issues are generally handled by your states health department or medical board. In these situations, you should not contact Medicare but go directly to the state agency responsible for overseeing health practices and facilities.
If you have a quality of care complaint, you should contact Medicare to connect with your local Beneficiary and Family Centered Care Quality Improvement Organization . This is the organization charged with handling Medicare complaints about the quality of care for beneficiaries.
Read Also: When Does My Medicare Coverage Start
How Much Does Medicare Cost
Original Medicare is divided into Part A and Part B .
- Part A helps pay for inpatient hospital care, some skilled nursing care, home health care and hospice care.
- Part B helps pay for doctor services, outpatient hospital care, durable medical equipment, home health care not covered by Part A, and other services. Medicare was never intended to pay 100% of medical bills. Its purpose is to help pay a portion of medical expenses. Medicare beneficiaries also pay a portion of their medical expenses, which includes deductibles, copayments, and services not covered by Medicare. The amounts of deductibles and copayments change at the beginning of each year.
Part A – Monthly Premium
If you are eligible, Part A is free because you or your spouse paid Medicare taxes while you were working. You earn Social Security “credits” as you work and pay taxes. For each year that you work, you earn 4 credits.
You are 65 or older, and you receive or are eligible to receive full benefits fr om Social Security or the Railroad Retirement Board
You are under 65, and you have received Social Security disability benefits for 24 months You are under 65, and you have received Railroad Retirement disability benefits and you meet Social Security disability requirements You or your spouse had Medicare-covered government employment You are under 65 and have End-Stage Renal Disease
When Should I Call Social Security Instead Of 1
- to request a replacement Medicare card,
- to report address, name, or phone number changes,
- to enroll in Medicare Part A and Part B,
- to discuss Medicare Part B billing issues,
- to apply for the Extra Help program for assistance with prescription drug costs,
- to appeal an Income-Related Monthly Adjustment Amount decision, if you are told you owe an income-based Part B and/or Part D premium.
Don’t Miss: Is Medicare Getting A Raise