Frequently Asked Questions About Medicare
My office assists many constituents with issues involving Medicare. Most often, questions involve eligibility, Medicare claims, and explanation of benefit forms. We also receive many questions about nursing homes, prescription drugs, and Medicare supplement insurance. If you are unable to resolve your problem through Medicare, my office may be able to assist you.
Please contact our District Office for immediate assistance at (718) 725-6000 and ask for the Medicare constituent services representative.
Medicare Links On-line:
- Medicare Beneficiary Information
- Medicare Plan Choices
- Prescription Drug Assistance Programs
- Medicare Physicians in Your Area
- First Gov
Medicare is a health insurance program for
- People age 65 and older
- Some people with disabilities
- People with End Stage Renal Disease (ESRD)
Medicare is administered by the Centers for Medicare & Medicaid Services (CMS)
Medicare enrollment is handled by the Social Security Administration (SSA)
Medicare Offers the Following:
- Part A (Hospital Insurance)
Assists with covering inpatient care in hospitals. This includes critical access hospitals and skilled nursing facilities. Part A helps cover skilled nursing facility care, hospice, and home health care. Individuals usually do not pay a monthly premium if Medicare taxes were paid while working.
- Part B (Medical Insurance)
Helps cover doctor’s visits, outpatient care, durable medical equipment, and other medical services. Part B also helps cover some preventive benefits.
- Part C (Medicare Advantage Plans)
An alternative to Original Medicare. Part C combines Part A, Part B, and Part D. The health plans are approved by Medicare and administered by private insurance companies. Part C’s premiums vary and it offers the same coverage as Original Medicare.
- Part D (Prescription Drug Coverage)
Helps pay costs of prescription drugs. The coverage varies and the user will incur out of pocket expenses such as co-payments, coinsurance, and deductibles. Extra assistance is available and is based on limited income and assets.
Frequently Asked Questions About Medicare:
How do I obtain a replacement Medicare card?
- You may contact your local Social Security Administration office or call the National Hotline at 1-800-772-1213.
How do I appeal a claims decision that I am not satisfied with?
- After a decision has been rendered, you will receive a Medicare Summary notice explaining whether your claim was approved or denied. If your claim has been denied, all appeal rights will be explained within the notice. Simply follow the directions contained within the notice.
How do I report an instance of fraud?
- If you believe Medicare has been billed for services you did not receive or Medicare has been over billed always contact your provider first to make sure a mistake has not been made. After you contact your provider, if you still believe fraud exists, contact Medicare's fraud hotline at 1-800-447-8477 or contact my office.
How do I determine if a particular nursing home is appropriate for my loved one?
- Medicare and the Centers for Medicare and Medicaid Services (CMS) provides a service called Nursing Home Compare. Nursing homes are rated by Medicare and CMS by the quality of care they provide. Medicare offers On-line information about nursing homes at its website, as well as numerous publications. If you do not have internet access, contact Medicare at 1-800-MEDICARE to obtain additional information.
For more information on Medicare, you can contact: