Troubleshooting Your Medicare

Your Rights & Protections as a Medicare Beneficiary

After decades of helping people understand the needlessly-complicated world of Medicare, you’d think I’d have more stories about the big problems that people have with their coverage. But the truth is, the moment our clients are enrolled in Medicare and paired with a Personal Benefits Manager, the complications seem to disappear.

Unfortunately, the time might come when you experience trouble with your Medicare coverage. This can be as simple as not being able to find the answer to your question, or as serious as being denied benefits for services that should be covered.

As a resource to anyone who is enrolled in Medicare, Medicare Advantage, or a Medicare supplement plan, here are some of the most valuable resources when it comes to troubleshooting your Medicare or filing Medicare complaints.

For Non-Critical Complaints: The Medicare Complaint Form

For complaints that are considered non-critical, the Medicare.gov website accepts web-based feedback via the Medicare Complaint Form. The information gathered here is used to improve Medicare over time, but response time can be as long as 30 days.

If you have a more urgent complaint that needs to be addressed immediately, you can call 1-800-MEDICARE and speak to a representative.

If you have called the Medicare helpline and are still having trouble resolving your issue, then it might be necessary to contact an outside organization or agency for help. Next up, we’ll look at some of the programs and agencies that have been set up specifically to help people solve their Medicare problems.

The Complaints, Grievances, & Information Requests: The Medicare Beneficiary Ombudsman (MBO)

The Medicare Beneficiary Ombudsman (MBO) was established in 2003 as a response to the increasing problems people were having with Medicare. Since its inception, the MBO has provided assistance for inquiries, grievances, appeals, and information requests.

The MBO is also responsible for providing an annual report to Congress about some of the larger concerns and issues surrounding Medicare and possible ways to improve it.

If you have already called 1-800-MEDICARE with a question or complaint and it is still not resolved, then ask the operator to submit your issue to the MBO.

For Personalized Health Insurance Counseling: Your State Health Insurance Assistance Program (SHIP

State-specific health insurance assistance programs (SHIP) exist to provide more personalized counseling on health insurance issues. SHIPs can answer questions about benefits, premiums, deductibles, general coverage info, and more. SHIPS are also good resources for individuals who are pursuing grievances or appeals to Medicare.

These agencies vary by state. Click here to visit the Medicare.gov contacts page, where you can find the organization that works in your area.

Reporting Abuse, Neglect, Mistreatment, or Unsafe Conditions: Your State Survey Agency.

In every state, the oversight of health care facilities and long-term care facilities is managed by a state agency. Usually, this is the Department of Public Health. Complaints made to the state survey agency may be investigated and corrected, and you might be asked to provide more information.

The Medicare.gov Contacts Page is where you can find information about your state’s official survey agency. Simply select your state and then choose the option that includes “State Survey Agency.”

For All Things Medicare: Your Personal Benefits Manager

If you are having trouble understanding your Medicare coverage, or if you are having issues receiving benefits, your Personal Benefits Manager is a valuable resource. Our team is comprised of expert professionals who know, perhaps better than anyone, how confusing Medicare can be. But more importantly, we know how to make it easy.

MediGap Advisors is a one-stop shop for educational resources on Medicare plans, Medicare Advantage plans, and Medigap plans. Or even better, you can call 1-800-913-3416 and speak directly to your very own Benefits Manager.

To your health and wealth,

Wiley P. Long, III
President – MediGap Advisors