How to Get Help When You Have Problems With Medicare

Do you have questions about Medicare? Are you having a problem with Medicare coverage or a Medicare claim? Have you searched the web until you’re frustrated but not been able to find an answer? Not sure where to turn?

Here are the top six resources for answering your Medicare questions and resolving your Medicare problems.

1

State Health Insurance Assistance Program (SHIP)

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Each state has a State Health Insurance Assistance Program, or SHIP, that offers one-on-one counseling and assistance to state residents. Your SHIP can help you with questions about Medicare benefits, premiums, and cost-sharing. It can also help you deal with problems signing up for a Medicare plan, complaints, and appealing a coverage or payment decision.

Depending on the state, the SHIP will be overseen by either the state's insurance commissioner (insurance department) or by the State Unit on Aging.

SHIPs are staffed primarily by volunteers who have undergone an extensive training program. If your SHIP volunteer doesn’t have an answer to your Medicare questions or can’t resolve your Medicare problems, they will know where to turn to get the answer or resolution.

SHIP names can vary from state to state. For example, the SHIPs in Massachusetts and Florida are called SHINE, short for Serving Health Information Needs of Seniors. California’s SHIP goes by the acronym HICAP, short for California Health Insurance Counseling & Advocacy Program. You can get contact information for your state’s SHIP here.

2

Medicare Rights Center

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The Medicare Rights Center is a non-profit organization dedicated to helping Americans understand their Medicare rights and benefits, navigate the Medicare system, and get quality health care.

It does this using the extensive library of information available on its website as well as through a telephone helpline. Helpline counselors offer assistance with Medicare questions like how to decrease your premium costs and with Medicare problems such as appealing payment denials. They can also provide extensive information regarding eligibility and enrollment, even for somewhat complicated situations.

The Medicare Rights Center also works to strengthen and protect the Medicare system via advocacy and policy work with lawmakers and government leaders.

And the Medicare Rights Center also runs Medicare Interactive, which helps people with Medicare navigate and understand their benefits and obtain answers to their questions.

You can educate yourself using the Medicare Rights Center website, or get personalized counseling using the helpline available Monday-Friday at 1-800-333-4114.

3

Senior Medicare Patrol (SMP)

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If your question or problem with Medicare involves a suspected error, fraud, or abuse of Medicare, the Senior Medicare Patrol is a great resource since it specializes in those areas.

The SMP provides one-on-one counseling to help you find and report healthcare billing errors. Your SMP counselor will also help you spot and report deceptive practices like being charged for services that weren’t provided or being provided with unnecessary healthcare services.

SMPs operate as a partnership between the U.S. Department of Health and Human Services and each state. SMPs are funded by government grants, but many SMP representatives are volunteers, and most of the volunteers are Medicare beneficiaries themselves.

Locate an SMP in your area through the SMP website or by calling the National Consumer Protection Technical Resource Center, known informally as the SMP Resource Center, at 877-808-2468. Calls will be answered Monday through Friday, 9:00 a.m. – 5:30 p.m. Eastern time.

SMP also has a contact form that you can fill out if your local SMP is unable to answer your question.

4

Medicare.gov

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The Medicare.gov website has general information about Medicare including information about who’s eligible, how to sign up, how much Medicare costs and the different types of Medicare.

You’ll be able to access step-by-step instructions for filing an appeal if Medicare isn’t paying for something you think is a covered benefit. You’ll also find instructions on how to file a complaint if you’re not satisfied with the quality of care or services you’ve received from a Medicare provider or health plan.

And the Medicare website also has a very helpful interactive plan finder tool that allows you to compare the available Part D and Medicare Advantage plans in your area, as well as a tool that will show you the available Medigap plans.

Medicare.gov also provides an annual "Medicare and You" handbook, which is available via a PDF download or email. It's also mailed to Medicare beneficiaries, if that's their preference.

Medicare.gov is the official government website about Medicare. There are lots of private sites devoted to Medicare information and sales—some are very reputable, although some are not. But only the government website has the dot-gov domain name.

5

MyMedicare.gov

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The information available on the MyMedicare.gov website differs from Medicare.gov in that it’s specific to you. You’ll be able to see your Medicare Part A and Part B claims as well as get quality information about hospitals and healthcare providers.

If you have a Medicare Advantage or Medicare Part D plan (both of which are sold by private insurers, as opposed to being run by the government, like Medicare Parts A and B), you’ll be able to get quality information about your health plan, also.

You can ask questions by using the live chat function accessed via a link near the top of the page. Using live chat, you and a Medicare representative converse by typing questions and answers into a pop-up box. I tried this myself and was assisted within 30 seconds by a knowledgeable representative even though it was 6:00 p.m. on a Saturday.

In order to access all of the resources on MyMedicare.gov, you’ll need to register using your Medicare number and create a login username and password. MyMedicare.gov needs your Medicare number in order to individualize the website for you. For example, without your Medicare number, it wouldn’t be able to provide specific information about your claims or what extra benefits your particular Medicare Advantage plan offers.

6

Call 1-800-MEDICARE (1-800-633-4227)

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You can call 1-800-MEDICARE and speak with a representative to ask questions about Medicare or get help resolving problems with Medicare.

We made a test call to this number and were greeted by a polite Medicare representative after being on hold for about 90 seconds. Although the representative didn’t immediately know the answer to our question about Medicare, she was able to look it up while we were on the phone with her.

We asked what resources she used to look up the answer, and she replied that she used the Medicare.gov website. She said all of the content she had access to was also available to the public on the Medicare.gov website.

Given that insight, we suggest you call 1-800-MEDICARE if you’re having trouble finding the information you need on the Medicare.gov website, don’t understand the information you’ve found on the website, or want to cut to the chase and speak with a human.

Understand that if you're calling during Medicare's annual election period (open enrollment) that runs from October 15 to December 7, you might have a longer wait time to speak with a representative.

Summary

If you're one of the more than 66 million Americans with Medicare benefits, you may find that you have questions about your coverage, plan options, or claims. Fortunately, there are a variety of unbiased resources that can help. Medicare's call center and website can be very useful, but there are also other resources and assisters available.

A Word From Verywell

If you're struggling with Medicare-related questions and seeking help from one of the sources listed in this article, it can be very helpful to have a trusted friend or family member with you during the process. They may be able to help you understand the answers you receive, or provide follow-up questions that can ensure that the issue is resolved in full without needing additional calls later on.

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Administration for Community Living. State Health Insurance Assistance Program (SHIP).

  2. Medicare Rights Center. Policy Work.

  3. Centers for Medicare and Medicaid Services. Senior Medicare Patrol.

Additional Reading
  • Caring.com. SHIP Offices in Your State

  • Medicare.gov: Medigap plan finder tool and Medicare Advantage/Part D plan finder tool.

  • MedicareRights.org

By Elizabeth Davis, RN
Elizabeth Davis, RN, is a health insurance expert and patient liaison. She's held board certifications in emergency nursing and infusion nursing.