Getting Answers to Health-Coverage Questions

Assistance is available for consumers dealing with Medicare and other providers.

No matter how savvy you are, if you’ve ever used the healthcare system, there’s a good chance you’ve been confused by something relating to your health. It could be a letter from Medicare or a private insurance company saying a service you need isn’t covered, or that your coverage is changing. It might be a bill from a doctor or lab you didn’t expect and don’t understand, or a brochure you read or a sales pitch you heard that left you with a lot of questions.

Health coverage can be confusing. Over the past decade, the number of coverage choices has increased. Television, mail, and the Internet bring us an overwhelming amount of information, and it’s not always reliable. So where can you turn for personalized, unbiased help with health insurance problems? Fortunately, every community has free resources that can give you (or a loved one) individualized counseling and assistance.

Medicare Questions

If you have a question about Medicare coverage, a good place to start is the 1-800-MEDICARE hotline. Staff members are trained to answer the most commonly asked questions about Medicare benefits, including individualized questions about your coverage. It’s a great way to get basic personalized information.

If you need one-on-one counseling to take a closer look at your problem and help you figure out your options, contact your local state health insurance assistance program (SHIP). SHIPs exist in every state, through the names of the organizations. They are designed to provide free, unbiased counseling and assistance to people with Medicare. This help can be as simple as explaining how benefits work. It can involve meeting face to face or over the phone to figure out which prescription drug, Medigap, or Medicare Advantage plans make the most sense for your particular situation, and which additional benefits you might be eligible for. Or, if you disagree with a bill you got or with a decision by Medicare or your Medicare Advantage or drug plan, SHIP counselors can help sort it out and file a request for an exception or an appeal (if needed). Many SHIP counselors are trained volunteers who are members of the community. To contact your SHIP, call 1-800-MEDICARE and request a referral to your local SHIP, or go to  shiptalk.org and click on “Find a State SHIP.”

Need more help? Local area agencies on aging can connect you with legal-services organizations in your area. Check eldercare.gov for a list of resources. National nonprofits like the Medicare Rights Center (medicarerights.org) and The Center for Medicare Advocacy (medicareadvocacy.org) can also help.

Other Health Insurance Issues

What if you’re not covered by Medicare? Many states have consumer assistance programs staffed by insurance experts that focus on other health insurance issues. For example, these programs help you file an appeal if your private insurance plan denies a claim. They can advise you on Medicaid issues or help you understand your rights and choices if you lose job-based coverage.

You can find contact information for consumer assistance programs online at familiesusa.org/resources/program-locator. The healthcare law provided much-needed funding to strengthen consumer assistance programs, and they are going to have an increasingly important role to play in the next few years.

So the next time you or a loved one is baffled by the complexities of Medicare or other types of health insurance, take a deep breath. Remember, you’re not on your own – there’s help out there for you!

 

 

 

 

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