What is the Medicare Beneficiary Ombudsman?

Last Updated : 01/08/20203 min read

Have you ever wanted to:

  • File a complaint or grievance with Medicare
  • Get help figuring out how your Medicare coverage will help pay for your medical costs
  • Or get answers to other questions about the program?

You’re not alone. As a Medicare beneficiary, you have a free resource provided by the Department of Health and Human Services to help you navigate the Medicare landscape and make informed health-care decisions for yourself and your family; this resource is called the Medicare Beneficiary Ombudsman.

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Here’s what you need to know about how to get help.

Medicare’s Ombudsman resource can tell you about your rights and protections under the program and offer guidance in filing complaints and grievances. The Ombudsman can also answer questions you may have about your Medicare services and costs.

For example, the Ombudsman might help you:

  • Find information to make the best health care decisions for yourself or a loved one
  • Understand your rights and protections under the Medicare program
  • Resolve a complaint or grievance with the way your Medicare benefits were administered
  • File an appeal to a payment or coverage decision
  • Sign up for — or leave — a Medicare Advantage plan or a Medicare Prescription Drug Plan

The Ombudsman also compiles data about the type of issues and complaints most frequently handled and shares that information with the Secretary of Health and Human Services to help continually improve the Medicare program. The Medicare Beneficiary Ombudsman resource is completely free to Medicare beneficiaries.

How do I reach the Medicare Beneficiary Ombudsman’s office?

If you have a Medicare-related issue, you can start by calling 1-800-MEDICARE (1-800-633-4227, or 1-877-486-2048 for TTY users) as a first step. Representatives are available 24 hours a day, seven days a week. If you still need help after talking with a representative, you can ask to have your inquiry referred to the Ombudsman.

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You can also approach your Ombudsman directly. The Medicare.gov website has a contact locator tool that will give you the information you need to get in touch with your Ombudsman, as well as other sources of assistance in your area.

The Medicare Beneficiary Ombudsman also coordinates with other resources at the state level to help you with your Medicare coverage issues, most notably the State Health Insurance Assistance Program, or SHIP. SHIPs are available in every state and the District of Columbia, and perform many of the same duties as the Medicare ombudsman, including personal counseling for beneficiaries and their families. You can find contact information for your state SHIP using this locator tool.

If you have questions about Medicare coverage in general, or about how to find Medicare plan options for yourself or to help a loved one, I would be happy to help you get the information you need. You can click the “View profile” button below to learn more about me. You can also click on one of the links below to request a phone call or a personalized email addressed to your specific needs. To get the ball rolling, click on the “Compare plans” button to see plans you may be eligible for in your area.

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