We hope that all of your health care experiences are positive. But if they’re not, we want filing a complaint to be as easy as possible. That’s why we offer you a variety of tools to express your concerns. One of those tools is the ability to file a complaint (sometimes called a “grievance”).
Is your concern a complaint or an appeal?
A complaint is different than an appeal. A complaint is about the way your Medicare health plan, Medicare drug plan, or health provider is giving care. Examples of complaints are problems with:
Things to know before you file a complaint
If you have a complaint with your plan, each plan has specific rules you’ll need to know and follow when filing a complaint. If, after filing a complaint, your plan doesn’t address the issue, call 1-800-MEDICARE for help. For any Medicare-related complaint, you can call your State Health Insurance Assistance Program (SHIP) for free personalized help.
If you’ve contacted 1-800-MEDICARE about a Medicare-related inquiry or complaint but still need help, ask the 1-800-MEDICARE representative to send your inquiry or complaint to the Medicare Ombudsman’s Office. The Medicare Ombudsman’s Office helps make sure that your inquiry or complaint is resolved.
In addition to basic information like your name and address, have your Medicare card and health plan card (if you have one) readily available when you’re ready to file your complaint. And, in the future, you can also use Medicare’s Blue Button to help. It provides you an easy way to download your personal health information to a file on your own personal computer. Check out the Blue Button through your account on MyMedicare.gov.
Did you know that by the year 2029, more than 20% of people in the U.S. will be at retirement age? Older adults are a vital part of our society. Since 1963, communities across the country have shown their gratitude by celebrating Older Americans Month each May. This year, to celebrate the Older Americans Act, we’re raising awareness about important issues facing older adults and highlighting how older Americans are advocating for themselves, their peers, and their communities.
Medicare helps older adults “Blaze a Trail” by helping them stay healthy and offering vital preventive services like mammograms, diabetes screenings, and colorectal cancer screenings. If you’ve had Part B for longer than 12 months, you can get an annual wellness visit to develop or update a personalized prevention help plan to prevent disease and disability based on your current health and risk factors.
No matter what your age is, you can stay healthy, get involved, and be a trailblazer for older Americans.
Brittle bones could shatter your life. Every year, more Americans are diagnosed with osteoporosis—a disease that causes bones to weaken and become more likely to break. You may not know that you have this “silent” disease until your bones are so weak that a sudden strain, bump, or fall causes your wrist to break or your hip to fracture.
Medicare can help you prevent or detect osteoporosis at an early stage, when treatment works best. Talk to your doctor about getting a bone mass measurement—if you’re at risk, Medicare covers this test once every 24 months (more often if medically necessary) when your doctor or other qualified provider orders it.
May is National Osteoporosis Awareness and Prevention Month. Learn more about what puts you at risk for osteoporosis and how to prevent and treat it at the National Osteoporosis Foundation. Watch our short video to learn more about how Medicare can help you protect your bones.
Did you know that hepatitis, an inflammation of the liver caused by a virus, kills nearly 1.4 million people worldwide every year?
Hepatitis is contagious. For example, the Hepatitis B virus spreads through contact with the blood or other body fluids of an infected person. People can also get infected by coming in contact with a contaminated object, where the virus can live for up to 7 days. Hepatitis B can range in severity from a mild illness lasting a few weeks to a serious illness that can lead to liver disease or liver cancer.
Medicare can help keep you protected from the most common types of hepatitis. Medicare Part B (Medical Insurance) covers Hepatitis B shots, which usually are given as a series of 3 shots over a 6-month period (you need all 3 shots for complete protection). Your risk for Hepatitis B increases if you have hemophilia, End-Stage Renal Disease (ESRD), diabetes, or certain conditions that lower your resistance to infection.
Generally, Medicare Part D (prescription drug coverage) covers Hepatitis A shots when medically necessary.
There’s a third type of Hepatitis—Hepatitis C. Medicare covers a one-time Hepatitis C screening test if your primary care doctor or practitioner orders it. It also covers yearly repeat screening if you meet one of these conditions:
- You’re at high risk because you have a current or past history of illicit injection drug use
- You had a blood transfusion before 1992, or
- You were born between 1945 and 1965
You pay nothing for the Hepatitis C screening test if the doctor or other qualified health care provider accepts assignment.
May is Hepatitis Awareness month. To find out more about preventing and treating hepatitis visit the Centers for Disease Control’s Hepatitis web page and check out our video.
When was the last time you checked your blood pressure? Now’s the time to take a fast (less than a minute) and simple test to see if your blood pressure is too high. High blood pressure usually has no signs or symptoms, but it can lead to a higher risk of heart disease, stroke, and kidney failure.
It’s important for you to know your blood pressure numbers, even when you’re feeling fine. Medicare helps make checking your blood pressure easy because it’s covered in your “Welcome to Medicare” preventive visit and yearly “wellness” visits at no cost to you.
If you have high blood pressure, you can control it with lifestyle changes and medicine. You may be at risk for high blood pressure if you:
- Eat salty foods
- Don’t exercise enough
- Drink more than a moderate amount of alcohol
- Have a family history of high blood pressure
- Are overweight
May is National High Blood Pressure Education Month. For more information on how you can combat high blood pressure, visit the Center for Disease Control’s high blood pressure web page and check out our video.
Nearly 200 countries celebrate Earth Day – a day for encouraging awareness and action for the environment on April 22nd. How can you make your voice heard this year? One great way is to sign up to get your “Medicare & You” handbook electronically.
If you have an eReader (like an iPad, Kindle Fire, Surface, or Galaxy Tab) you can download a free digital version of the Medicare & You handbook to your eReader and take it with you anywhere you go.
Don’t have an eReader? You can still sign up to get a paperless version in a few simple steps. We’ll send you an email in September when the new eHandbook is available. The email will explain that instead of getting a paper copy in your mailbox each October, you’ll get an email linking you to the online version of “Medicare & You.” This online version of the handbook contains all the same information as the printed version.
Even better, the handbook information on Medicare.gov is updated regularly, so you can be confident that you have the most up-to-date Medicare information!
Sign up today to get your Medicare & You information electronically, and you’ll be making a difference for the environment. What a great way to make your voice heard and celebrate Earth Day.
There are a lot of changes that happen with age, and some of them, like physical pain, loss of mobility, and loneliness can lead to alcohol misuse. As people age, they become more sensitive to the effects of alcohol. Over time, someone’s drinking habits may become a problem.
Older adults who drink may be at a higher risk for falls or other injuries. And alcohol can make some health problems worse, including diabetes, high blood pressure, and heart problems. It can also cause bad interactions when mixed with prescription or over-the-counter medications. The National Institute on Alcohol Abuse and Alcoholism recommends adults 65 and over who are healthy and don’t take medications have no more than 3 drinks on a given day or 7 drinks in a week.
If you think you or a loved one could be misusing alcohol, don’t be ashamed to ask for help. April is Alcohol Awareness Month, and it’s the perfect time to remember that Medicare covers alcohol misuse screening & counseling to provide counseling for people who misuse alcohol.