Medicare Questions and Problems—Where to Get Help

The Top Six Resources for Questions About Medicare and Problems With Medicare

Do you have questions about Medicare? Are you having a problem with Medicare coverage or a Medicare claim? Have you searched the web until you’re frustrated but not been able to find an answer? Not sure where to turn?

Here are the top six resources for answering your Medicare questions and resolving your Medicare problems.
 

1
State Health Insurance Assistance Program

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If you have questions about your Medicare coverage, there are lots of resources to help you get answers. John Clines/E+/Getty Images

Each state has a State Health Insurance Assistance Program that offers one-on-one counseling and assistance to state residents. Your SHIP can help you with questions about Medicare benefits, premiums and cost sharing. It can also help you deal with problems signing up for a Medicare plan, complaints, and appealing a coverage or payment decision.

SHIPs are staffed primarily by volunteers who have undergone an extensive training program. In the unlikely event that your SHIP volunteer doesn’t have an answer to your Medicare questions or can’t resolve your Medicare problems, he or she will know where to turn to get the answer or resolution.

SHIP names can vary from state to state. For example, the SHIPs in Massachusetts and Florida are called SHINE, short for Serving Health Information Needs of Seniors. California’s SHIP goes by the acronym HICAP, short for California Health Insurance Counseling & Advocacy Program. You can get contact information for your state’s SHIP here.

2
Medicare Rights Center

The Medicare Rights Center is a non-profit organization dedicated to helping older Americans understand their Medicare rights and benefits, navigate the Medicare system and get quality health care.

It does this using the extensive library of information available on its website as well as through a telephone help line. Help line counselors offer assistance with Medicare questions like how to decrease your premium costs and with Medicare problems such as appealing payment denials.

You can educate yourself using the Medicare Rights Center website, or get personalized counseling using the help line available Monday-Friday at 1-800-333-4114.

3
Senior Medicare Patrol

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If your question or problem with Medicare involves a suspected error, fraud, or abuse of Medicare, the Senior Medicare Patrol is a great resource since it specializes in those areas. The SMP provides one-on-one counseling to help you find and report health care billing errors. Your SMP counselor will also help you spot and report deceptive practices like being charged for services that weren’t provided or being provided with unnecessary health care services.

Many SMP representatives are volunteers, and most of the volunteers are Medicare beneficiaries themselves.

Locate an SMP in your area through the SMP website or by calling the National Consumer Protection Technical Resource Center, known informally as the SMP Resource Center, at 877-808-2468. Calls will be answered Monday through Friday, 9:00 a.m. – 5:30 p.m. Eastern time.

4
Medicare.gov

The Medicare.gov website has general information about Medicare including information about who’s eligible, how to sign up, how much Medicare costs and the different types of Medicare. You’ll be able to access step-by-step instructions for filing an appeal if Medicare isn’t paying for something you think is a covered benefit. You’ll also find instructions on how to file a complaint if you’re not satisfied with the quality of care or services you’ve received from a Medicare provider or health plan.

5
MyMedicare.gov

A companion site to Medicare.gov, the information available on the MyMedicare.gov website differs from Medicare.gov in that it’s specific to you. You’ll be able to see your Medicare Part A and Part B claims as well as get quality information about your doctors, hospitals, and other health care providers. If you have a Medicare Advantage or Medicare Part D plan, you’ll be able to get quality information about your health plan, also.

You can ask questions by using the live chat function accessed via a link near the top of the page. Using live chat, you and a Medicare representative converse by typing questions and answers into a pop-up box. I tried this myself and was assisted within 30 seconds by a knowledgeable representative even though it was 6:00 p.m. on a Saturday.

In order to access all of the resources on MyMedicare.gov, you’ll need to register using your Medicare number and create a login username and password. MyMedicare.gov needs your Medicare number in order to individualize the website for you. For example, without your Medicare number, it wouldn’t be able to provide specific information about your claims or what extra benefits your particular Medicare Advantage plan offers.

6
Call 1-800-MEDICARE (1-800-633-4227)

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You can call 1-800-MEDICARE and speak with a representative to ask questions about Medicare or get help resolving problems with Medicare.

I made a test call to this number and was greeted by a polite Medicare representative after being on hold for about 90 seconds. Although the representative didn’t immediately know the answer to my question about Medicare, she was able to look it up while I was on the phone with her.

I asked what resources she used to look up the answer, and she replied that she used the Medicare.gov website. She said all of the content she had access to was also available to the public on the Medicare.gov website.

Given that insight, I suggest you call 1-800-MEDICARE if you’re having trouble finding the information you need on the Medicare.gov website, don’t understand the information you’ve found on the website, or want to cut to the chase and speak with a human.

About.com's Medicare & Medicaid Site

About.com has an entire site dedicated to helping you understand and get the most from your Medicare & Medicaid coverage. http://medicare.about.com/

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