Your Right to Accurate Information About Medicare - dummies

Your Right to Accurate Information About Medicare

By Patricia Barry

Copyright © 2015 AARP

People often receive information about Medicare that’s just plain wrong. If it comes from family, friends, doctors, insurance agents, employers’ benefits administrators, and so on — well, it’s not their fault because none of them can be regarded as reliable sources on Medicare’s complexities.

But sometimes the inaccurate information comes from Social Security and Medicare officials themselves, whose job is to help Medicare beneficiaries understand the law and navigate its maze of regulations.

Many officials go out of their way to be helpful, and very often the information they provide is reliable. The POMS manual — the Program Operations Manual System, Social Security’s “bible” of guiding instructions — is there to help. Medicare officials also have a whole raft of references in their manual system, with regulations on every aspect of coverage, payment, coordination of benefits, and many more topics.

Following are strategies that can help you in the quest for accurate information.

Knowing whom to call

For historical reasons, the administration of Medicare is divided between two federal agencies: the Social Security Administration (SSA) and the Centers for Medicare & Medicaid Services (CMS). So putting your questions to the appropriate officials may be half the battle. The following sections note which agency to contact about Medicare issues in different circumstances.

Social Security Administration

Contact SSA (800-772-1213 or TTY 800-325-0778) or go to its website about

  • Eligibility for Medicare

  • Medicare enrollment and disenrollment

  • Applying for low-cost drug coverage under the Extra Help program

  • Paying higher-income premiums and requesting waivers

  • Paying Part B late penalties

  • Obtaining a replacement Medicare card

  • Reporting a change of address or a death

  • All questions about Social Security retirement and survivor benefits, disability benefits (SSDI), and Supplemental Security Income (SSI)

Centers for Medicare & Medicaid Services

Contact CMS through the Medicare help line (800-633-4227 or TTY 877-486-2048) or go to its website about

  • Medicare coverage for medical services and supplies

  • Choosing a Medicare Advantage plan or Part D drug plan

  • Choosing Medicare supplemental insurance (Medigap)

  • Billing and payment questions

  • Finding doctors who accept Medicare patients in your area

  • Finding a Medicare-approved medical equipment supplier in your area

  • Comparing the quality of hospitals, nursing homes, and home health agencies in your area

  • Appealing a payment or coverage decision you don’t agree with

  • Reporting fraud

Seeking a second opinion

The call lines for both Social Security and Medicare are staffed by customer service representatives who have a certain amount of training but aren’t equipped to answer every question that comes in. If they don’t know the answer, they should consult a supervisor, but they don’t always do so. And sometimes they confidently provide an answer that isn’t actually accurate.

If you have doubts about an answer, sometimes the simplest solution is to hang up and call again. You’ll get a different person and maybe a different answer. In that case, ask to speak to a supervisor yourself and if necessary ask him or her to look up the specific regulation related to your query. Always note down the date and time of your call, the name of the person you talk to, and the citation for the regulation in question (if you’re told it).

Another way of seeking a second opinion on whether the information you receive is for real or not is to call your State Health Insurance Assistance Program (SHIP), which has trained counselors to personally answer questions on Medicare at no charge.