Medicare's toll-free number offers beneficiaries access such as information as availability of Medicare plans, list of providers, and help filing appeals. | Image: DragonImages / stock.adobe.com
- Medicare offers a toll-free number that’s staffed 24 hours a day, seven days a week.
- Beneficiaries can call for Medicare information or to enroll in a plan or make an appeal.
- Callers can choose from a handful of menu options.
- Beneficiaries can also mail or fax Medicare or request information in an accessible format.
- Medicare.gov’s online resources are extensive and searchable by state or territory.
- The SHIP program offers free counseling and resources in each state.
What is the Medicare phone number?
Medicare provides beneficiaries with an easy-to-remember 800 number: 1-800-MEDICARE. (That’s 1-800-633-4227.)
When can I call Medicare for help?
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.
When should I call 1-800-MEDICARE?
Beneficiaries can call the toll-free Medicare number to:
- ask whether certain services are covered,
- get detailed information about Medicare health and prescription drug plans in your area, including costs and services,
- choose and enroll in a Medicare health or prescription drug plan,
- find a Medigap policy in the area,
- request a list of Original Medicare physicians, healthcare providers, and suppliers,
- request information and forms necessary for filing a Medicare appeal – or begin an appeal verbally,
- authorize someone to speak with Medicare on your behalf,
- compare quality ratings for skilled nursing facilities, hospitals, home health agencies, and dialysis facilities,
- request Medicare publications.
The menu of options at 1-800-MEDICARE
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. (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.
- Press “1” for Claim Status to find out a claim status, and the time limits to file your particular Medicare claim. Remember, these representatives can only help you with Original Medicare claims issues. If you have a question about a provider bill, first contact your provider to see whether they can help you resolve it. You can also press “1” if you need assistance paying for your Medicare premiums and cost sharing through a Medicare Savings Program (MSP). (However the easier way to apply for an MSP is by contacting your local Medicaid office.)
- Press “2” for Coverage & Benefits for help with plan options, issues, Medicare Advantage and Part D enrollment, and covered services. For additional information about these topics, you can visit Medicare.gov.
- Press “3” for Premiums – For most Medicare beneficiaries, Part A has no premiums if you or a spouse worked and paid Medicare taxes for 40 quarters (10 years). For beneficiaries who haven’t reached the 40-quarter threshold, Part A premiums can cost up to $458 per month in 2020, depending on how long you paid into Social Security. Premiums for Part B are $144.60 a month in 2020. Both Part B and Part D premiums can be higher for those earning over $87,000 annually (over $187,000 for a couple filing jointly).
- Press “4” for Preventive Exams to hear about preventive healthcare services covered by Medicare. These services can include annual wellness visits, mammograms, glaucoma tests, bone mass measurements, and colorectal cancer screenings (among many others).
- Press “5” for Deductible – Medicare has annual deductibles, and keeping track of these can be pivotal to fully using your coverage. Contact Medicare for your current deductible status and how close you are to meeting them. It is important to note that Part A has a benefit period based deductible – not an annual deductible like Part B. This Part A benefit period includes a set time for skilled nursing or hospital care – typically starting on the day a patient is admitted as an inpatient and concluding 60 days after the services were completed. Currently, the Medicare Part A deductible is $1,408 per benefit period in 2020, and Part B is $198 per year.
- Press “6” for help with something else.
- Press “0” to speak with an agent.
How else can I contact Medicare?
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.
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 firstname.lastname@example.org. (This email fields requests for accessible format information only.)
What information can I find at Medicare.gov?
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:
- view and print a copy of your Medicare card,
- track Original Medicare claims and your Part B deductible,
- register for electronic Medicare Summary Notices (eMSNs),
- update and manage your medical information (diagnosis, conditions, allergies, and implanted devices),
- view the Medicare & You handbook electronically,
- update your drug list and pharmacy information,
- manage your providers.
Where else can I get Medicare advice?
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.
When should I call Social Security instead of 1-800-MEDICARE?
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:
- to verify your Medicare eligibility,
- to report a death,
- to request a replacement Medicare card,
- to report address, name, or phone number changes,
- to enroll in Medicare Part A and Part B,
- to discuss Medicare Part B (or Part A) billing issues,
- to apply for the Extra Help program for assistance with prescription drug costs,
- to appeal an Income-Related Monthly Adjustment Amount (IRMAA) decision, if you are told you owe an income-based Part B and/or Part D premium.
When should I not call 1-800-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.