Questions and Answers
Q. I want to file an appeal with Medicare about how long it takes for me to see my doctor at each appointment. I sit in the waiting room past my appointment time, sometimes for as long as 20 minutes, and then I sit in the exam room another 15 to 30 minutes waiting to be seen! I don’t think Medicare should pay for the last appointment I had. What should I do?
A. What you describe is a quality issue and therefore is a complaint or grievance, in the language of Medicare. You can file a complaint if you have concerns about the quality of care or other services you get from a Medicare provider. An appeal is filed if you have an issue with a plan’s refusal to cover a service, supply, or prescription.
Individuals can file complaints about a doctor, hospital, or other Medicare provider; about your health or drug plan; about the quality of care received; about dialysis or kidney treatment care; or about durable medical equipment (DME.) How you file a complaint depends upon what your complaint is about. To file a complaint about a doctor, for instance, could involve improper care, incompetent practice, or unprofessional conduct, and these are best directed to the State Medical Board. For complaints about DME, individuals can contact Medicare directly at 1-800-MEDICARE (1-800-633-4227.)
Quality of care complaints could include, but aren’t limited to, errors in medicines prescribed or treatments ordered, not getting proper treatment after a change in your condition, excessive wait times, or incomplete instructions upon discharge from a hospital or nursing home. These types of complaints should be directed to the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) which is a third-party oversight organization. In Michigan, this entity is Livanta and contact can be made by calling 888-524-9900, or by going to https://Livantaqio.com and clicking on the File Complaint icon.
For more information about complaints and appeals you can call 800-633-4227 or go online to Medicare.gov, or contact our Michigan Medicare and Medicaid Assistance Program (MMAP) at
800-803-7174.
Q. My sister doesn’t get her Medicare Part B charge taken out of her Social Security check. How can I qualify for this discount?
A. It sounds like your sister has one of the Medicare Savings Programs (MSP) also known as Medicare Buy-in Programs. MSPs are state programs that assist with paying Medicare costs, including Part B premiums and sometimes Part A premiums. One kind of MSP, the Qualified Medicare Beneficiary, or QMB, also pays for deductibles, coinsurances, and copayments. Another kind of MSP is available to some Medicare beneficiaries who are under 65 and work. Each MSP has different benefits and eligibility requirements. To qualify for an MSP, you must have Medicare Part A and meet income and asset guidelines. You will be enrolled in the MSP that corresponds to your income, assets, and other application details. Medicare Savings Programs are available to all eligible people with Medicare, not just those enrolled in certain Medicare Advantage Plans.
If you enroll in an MSP, you will automatically get Extra Help, the federal program that helps pay your Medicare prescription drug (Part D) plan costs. Another benefit of enrolling in an MSP is that it will allow you to enroll in Part B outside of the regular enrollment periods. This is important because you usually must wait to sign up during the General Enrollment Period, or GEP, if you did not sign up when you were first eligible. Additionally, enrolling in an MSP will eliminate your Part B late enrollment penalty if you have one. You will not have the penalty even if you later lose MSP eligibility. The QMB MSP will also eliminate your Part A late enrollment penalty if you have one.
To apply for an MSP contact your local Medicaid office or other state agency that receives MSP applications. You can also contact our MMAP line at 800-803-7174 for help applying. You will usually need to send in copies of your Social Security card, Medicare card, birth certificate, and/or proof of income and assets with your application. Medicaid should respond in about 45 days. If you are approved for the MSP, it can take up to three months for your benefits to start but you will be reimbursed for any premiums paid during those months. If you are approved, you will need to renew your MSP every year.