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Who should I contact if I have an issue with my Medicare coverage?
You can usually address many Medicare Advantage or Part D enrollment issues by contacting Social Security or 1-800-MEDICARE. But you have to appeal coverage denials directly to your insurer.
Medicare beneficiaries can call an easy-to-remember toll-free number – 1-800-MEDICARE – for information such as specific billing questions and questions about claims. (That’s 1-800-633-4227.)
The toll-free phone line is staffed 24 hours a day, seven days a week. Before you dial though, remember that almost all Medicare-related questions can be answered through easily accessible and authorized sources, including official web resources, health plan navigators, and consumer advocates.
Beneficiaries can call the toll-free Medicare number to:
Before you dial, be prepared with a list of the topics you want to talk about and questions you need answered. Make sure to have your Medicare number – and if you are inquiring about a claim or appeal, it’s helpful to have your most recent Medicare Summary Notice available.
The representatives at 1-800-Medicare can help you with claims and appeals issues if you have Original Medicare. You should contact your insurer directly about claims or billing issues if you have Medicare Advantage or Part D coverage, or if you need to check on claims that are being processed by your Medigap supplement. (You can also call 1-800-MEDICARE to file a complaint about your health insurance plan.) If you would like someone else to speak on your behalf or represent you in an appeal, you will need to give a verbal authorization to the Medicare agent.
When you reach the menu, you will be greeted by a “Yes” or “No” question asking whether you are calling about a processed or denied claim. If you reply “Yes” you will be prompted to supply your date of birth and other identifying information. If “No,” you will hear the following menu that will route your call to an agent based on the reason you’re calling.
You can mail your questions or hard copies of documents to:
Medicare Contact Center Operations
PO Box 1270
Lawrence, KS 66044
Or fax Medicare at 1-844-530-3676.
Medicare also has a live chat service that you can use to seek help or information in a text format online. This service is available 24/7.
Currently, Medicare does not offer an email option for general information and questions.
To request information in an accessible format (Braille, large print, data/audio files, relay services and TTY communications) call 1-877-486-2048 or email Medicare at [email protected]. (This email fields requests for accessible format information only.)
Medicare.gov contains a treasure trove of contact information and details about Medicare coverage. For contact information, visit the contact page of the website and enter your state or territory; then choose the organization or topic from a dropdown menu.
For complete “do-it-yourself” Medicare access, visit MyMedicare.gov, and set up your own account with a user name and password. Your own MyMedicare.gov account will allow you to:
State Health Insurance Assistance Programs (SHIPs) are free volunteer-based Medicare counseling services available in each state. These programs provide unbiased counseling about Medicare questions – including details about coverage, benefits, and costs (such as premiums, deductibles, and coinsurance). SHIPs can also assist beneficiaries with complaints or appeals. Importantly, SHIPs can also assist with coverage changes like choosing the right Medicare Advantage or Part D plan for your needs.
Although Social Security and Medicare are linked in many ways, the Social Security Administrations manages enrollment and eligibility for Medicare benefits. These are the times when you should call Social Security (1-800-772-1213) instead of Medicare:
Do not call 1-800-MEDICARE if you have specific questions about your Medicare Advantage (Part C) or Part D plan. Because these policies are administered by private insurers, you must contact your plan insurer directly (or your agent/broker). This includes questions on plan premiums, deductibles, claims status, and other issues that are plan-specific. (Medicare can sometimes assist with Medigap claims issues, though, if your Medigap plan is not receiving claims once they’ve been processed by Original Medicare.)
You can also call 1-800-MEDICARE for general Medicare questions not mentioned in this article.
Jesse Migneault is a journalist and editor who has written about business, government and healthcare – including public and private-payer health insurance. His articles have appeared in HealthPayerIntelligence, the Hartford Courant, Portsmouth Herald, Seacoastonline.com, Foster’s Daily Democrat, and York County Coast Star.
In addition, his work has been cited by health industry stakeholders such as the Eugene S. Farley Health Policy Center, Association of Healthcare Journalists, American Academy of Actuaries, Kaiser Permanente, blueEHR, San Diego Law Review, Medicare Agent News, healthjournalism.org, and Concierge Medicine among others.