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 Basics:
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:
NE SHIIP
1-800-234-7119
www.doi.ne.gov/shiip
MEDICARE
1-800-633-4227
www.medicare.gov