With Medicare, you have special rights and protections. There are resources available to you to make sure your rights are protected, including:
- The Medicare Beneficiary Ombudsman
- The Competitive Acquisition Ombudsman (CAO)
- Your State Health Insurance Assistance Program (SHIP)
- The Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO)
The Medicare Beneficiary Ombudsman
The Medicare Beneficiary Ombudsman helps you with Medicare-related complaints, grievances, and information requests. The Medicare Beneficiary Ombudsman makes sure information is available about:
- What you need to know to make health care decisions that are right for you
- Your Medicare rights and protections
- How you can get issues resolved
The Medicare Beneficiary Ombudsman also shares information with the Secretary of Health and Human Services, Congress, and other organizations about what does and doesn’t work well to improve the quality of the services and care you get through Medicare.
If you’ve contacted 1-800-MEDICARE about a Medicare-related inquiry or complaint but still need help, ask the 1-800-MEDICARE representative to send your inquiry or complaint to the Medicare Ombudsman’s Office. The Medicare Ombudsman’s Office helps make sure that your inquiry or complaint is resolved.
The Competitive Acquisition Ombudsman (CAO)
The CAO helps review and resolve complaints about durable medical equipment (DME) from people with Medicare and suppliers in Competitive Bidding Areas. The CAO responds to individual and supplier inquiries, issues, and complaints, and helps make sure that your complaint is resolved.
If you still need help after contacting your supplier and 1-800 MEDICARE, ask the 1-800-MEDICARE representative to send your inquiry or complaint to the CAO. The CAO helps make sure that your inquiry or complaint is resolved.
State Health Insurance Assistance Program (SHIP)
SHIPs offer local, personalized counseling and assistance to people with Medicare and their families.
SHIPs provide free information and counseling to help you with:
- Your Medicare questions, including your benefits, coverage, premiums, deductibles, and coinsurance
- Complaints (grievances)
- Joining or leaving a Medicare Advantage Plan (Part C) (like an HMO or PPO), any other Medicare health plan, or Medicare Prescription Drug Plan (Part D).
For more information, call your SHIP.
Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO)
The BFCC-QIOs review complaints and quality of care for people with Medicare in order to improve the effectiveness, efficiency, economy, and quality of services delivered to people with Medicare.
BFCC-QIOs provide services to help you with:
- Filing appeals in hospital and non-hospital settings if you think your coverage is ending too soon
- Complaints (grievances)
- Quality of care reviews
- Medical necessity reviews
For more information or help, call your BFCC-QIO.
The State Survey Agency
State Survey Agencies oversee health care facilities that participate in the Medicare and/or Medicaid programs. The State Survey Agency inspects health care facilities and investigates complaints to ensure that health and safety standards are met. If you have a complaint about improper care or unsafe conditions in a hospital, home health agency, hospice, or nursing home, or you’re concerned about the health care, treatment, or services that you or another person got or didn’t get in a health care setting, you can contact your State Survey Agency. You can contact the State Survey Agency if you have concerns about things like:
- Poor care
- Not enough staff
- Unsafe or unsanitary conditions
- Dietary problems