Strategies to avoid, identify and resolve Medicare issues
August 1, 2021 | View PDF
In the past, you may have had trouble navigating the maze of Medicare. Here are some helpful strategies to avoid, identify and solve Medicare issues that you may encounter.
Know your coverage
Medicare coverage rules can be complicated. My advice is to not become overwhelmed. Before receiving a service, you do not need to be a Medicare specialist. My recommendation is to check to make sure Medicare covers the service and if there are any steps you must take prior to receiving it. If Original Medicare, your employer-provided retiree benefits and/or Medigap Plan, does not cover a service, it may be because you did not follow or meet coverage rules. An example of this happening would be sometimes Medicare will only cover certain preventive screenings if you meet a specific criterion. A service also may not be covered if it is an excluded service. An example of an excluded service is elective cosmetic surgery.
There are a few options to learn about Original Medicare’s coverage of a service. You can call Medicare directly at 1-800-MEDICARE (1-800-633-42273), open seven days a week, 24 hours a day, visit the Medicare website (Medicare.gov), read the relevant sections of the “Medicare & You” handbook or speak with your provider.
To learn about your employer provided retiree benefits and/or Medigap plans coverage, you will need to call your plan directly or read your plan’s handbook.
The Medicare Summary Notice, or MSN, is a document sent to people with Original Medicare. The Medicare Summary Notice statement should be reviewed for accuracy of services received, expense to Medicare and the amount that is your responsibility to pay. Also, check the notes section of the statement. This is where Medicare may further explain its payment decision or give you other important information.
Your review helps keep your benefits correct and can help prevent Medicare fraud.
If you have a Part D plan, you will receive an Explanation of Benefits, or EOB. An EOB is a summary of your medications purchased.
MSNs are mailed quarterly, while EOBs are usually sent monthly. If you haven’t used any medical or prescription services, don’t be concerned if you do not receive statements. Statements are only sent when you have received medical related services or medications.
Both MSNs and EOBs show the amount that Medicare or your private plan was billed, the amount that they paid on your claim and the amount that is your responsibility to pay. It is important to note that neither an MSN nor an EOB is a bill.
After reviewing your statements, and if you disagree with a non-covered charge, you may decide to file an appeal. Instructions and deadlines regarding appeals will be on the final page of your MSN, titled “How to Handle Denied Claims or File an Appeal”. Part D plans will send you a notice if denying prescription drug coverage. If you receive a denial notice, read it carefully to guide your appeal and to ensure that your appeal addresses the plan’s reason for denial.
There are a few different places you can contact for Medicare assistance, depending on your issues or questions. You should contact the Social Security Administration (SSA) for Medicare Part A and B enrollment, premium issues, update your address and/or contact information. For other matters concerning Medicare, call 1-800-MEDICARE (1-800-633-42273) or use their website http://www.Medicare.gov. You can contact either SSA or Medicare to request a replacement Medicare card. For questions or issues with your Part D or Medigap plan, you should contact your plan directly to learn about its coverage rules, costs, appeal a coverage decision or to file a grievance about poor customer service or administrative errors.
For any Medicare related questions feel free to contact the State of Alaska Medicare Information Office at 1-800-478-6065 or 907-269-3680, also known as the Alaska SHIP, SMP and MIPPA.
Heather Anderson is the Office Assistant II for the State of Alaska Medicare Information Office.