How the Medicare Beneficiary Ombudsman Works for You


How the Medicare Beneficiary Ombudsman Works for You

The Medicare Beneficiary Ombudsman helps you with complaints, grievances, and information requests. The Medicare Beneficiary Ombudsman makes sure information is available about the following:
•What you need to know to make health care decisions that are right for you
•Your rights and protections under Medicare
•How you can get issues resolved
The Medicare Beneficiary Ombudsman also shares information with the Secretary of Health and Human Services, Congress, and other organizations about what works well and what doesn’t work well to improve the quality of the services and care you get through Medicare.

How to get help in your area

The Medicare Beneficiary Ombudsman works with organizations such as State Health Insurance Assistance Programs (SHIPs). SHIPs are state programs that provide free local health insurance counseling to people with Medicare and national Medicare beneficiary advocacy organizations to make sure your issues are resolved. These organizations provide information, counseling, and assistance to help you with the following:
•Your Medicare questions, including your benefits, coverage, premiums, deductibles,and coinsurance
•Grievances (complaints)
•Appeals (if you disagree with a coverage or payment decision made by Medicare or your Medicare plan)
•Problems joining or leaving a Medicare Advantage Plan (like an HMO or PPO) or any other Medicare health plan or Medicare Prescription Drug Plan

You can find the phone number for your state’s SHIP by visiting www.medicare.gov/contacts or by calling 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

For more information

•Visit www.medicare.gov and select “Ombudsman” under “Help & Support” to get information about how to get your Medicare questions and complaints handled.
•Visit the Medicare Beneficiary Ombudsman’s Web site at www.cms.hhs.gov/center/ombudsman.asp.
•Call 1-800-MEDICARE (1-800-633-4227) to get help with your Medicare questions and concerns. TTY users should call 1-877-486-2048. If your inquiry requires a response from the Medicare Beneficiary Ombudsman, a 1-800-MEDICARE representative can direct your inquiry to the Medicare Ombudsman as needed.
•Visit www.medicare.gov and select “Have a Complaint about Your Care?” under “Need Help” to submit feedback about your Medicare health plan or prescription drug plan directly to Medicare.