If you’re enrolled in Medicare, you have certain guaranteed rights and protections that you can expect. A Medicare ombudsman is someone who makes sure that your rights are protected and helps you if they’re violated. This important position is responsible for helping at-risk seniors find the aid they need if something goes wrong with their coverage.
If you have complaints or issues with Medicare, enlisting the aid of an ombudsman can make all the difference.
What and How Does the Medicare Ombudsman Help?
When you hear about an ombudsman for Medicare, they’re generally referring to a Medicare Beneficiary Ombudsman, sometimes called an MBO. Congress established the position of MBO in 2003 to serve the needs of Medicare’s beneficiaries and other stakeholders. They act as advocates for your rights in regard to the benefits you receive from Medicare insurance. If you have any complaints, grievances, or questions about Medicare, an ombudsman will help solve them.
If you have any complaints, grievances, or questions about Medicare, an ombudsman will help solve them.
Specifically, an MBO should provide information to guide you toward resolving your issues, ensuring your Medicare program rights are protected, and making health care choices that are right for you. The MBO also works with the Secretary of Health and Human Services, Congress, and other groups to improve the Medicare program based on feedback from beneficiaries.
Are There Other Kinds of Medicare Ombudsman?
The Medicare program also employs the position of Competitive Acquisition Ombudsman, sometimes called CAOs. This type of ombudsman is more involved with durable medical equipment (DME). If you require DME or are having issues getting the equipment you need, a CAO can help. CAOs largely deal with the competitive bidding program and competitive bidding areas for Medicare’s DME carriers.
If you require DME or are having issues getting the equipment you need, a Competitive Acquisition Ombudsman can help.
CAOs act very similar to MBOs in that they’re a go-between for beneficiaries, Medicare, and carriers. They’re also instrumental in pushing for improvements in Medicare insurance coverage. The biggest difference is that CAOs focus on DME, whereas MBOs are more generalists.
How Can I Find One?
If you need the help of an ombudsman, one easy way to get into contact is by reaching out to your State Health Insurance Assistance Program (SHIP). The ombudsman will work with SHIPs to provide health care counseling and assistance. You can also contact the ombudsman through the Medicare program by calling 1-800-MEDICARE and asking the call representative to submit your issue or question to the ombudsman.
You can contact the ombudsman by calling 1-800-MEDICARE and asking the call representative to submit your issue or question to the ombudsman.
While not the only way to solve issues you experience with the Medicare program (the appeal process is pretty effective), the Medicare ombudsman is a powerful ally in understanding and improving your Medicare insurance coverage.