Medicaid is a federal and state program that provides health coverage for certain people with limited income and assets. Each state runs different Medicaid-funded programs for different groups of people, including: Older adults People with disabilities Children Pregnant people Parents and/or caretakers of children All states also have Medicaid programs
Resources if you need dental coverage
If you need dental coverage, you may be able to get assistance through the programs listed below. Medicare Advantage Plans: Some Medicare Advantage Plans offer routine dental coverage. Contact your plan to learn about services it may cover, any rules or restrictions, and costs. If you are considering joining Medicare
Qualified Health Plan (QHP) basics
Qualified Health Plans (QHPs) are health insurance policies that meet protections and requirements set by the Affordable Care Act (ACA). Specifically, QHPs must: Follow federally established cost-sharing limits Provide essential health benefits Meet the “minimum essential coverage” (MEC) requirement, also known as the individual mandate If you are not enrolled
Help understanding Medicare benefits and options
If you need help understanding your Medicare rights and how to exercise them, there is free information and assistance that you can access. Below are examples of places you can get help: State Health Insurance Assistance Program (SHIP) – Each state offers a SHIP, partly funded by the federal government,
Appealing the Part D late enrollment penalty
If you were without Part D or creditable drug coverage for more than 63 days while eligible for Medicare, you may face a Part D late enrollment penalty (LEP). The purpose of the LEP is to encourage Medicare beneficiaries to maintain adequate drug coverage. The penalty is 1% of the
Part D appeals
Part D appeals Introduction to Part D appeals Requesting a tiering exception The Medicare Prescription Drug Coverage and Your Rights notice Appealing the Part D late enrollment penalty
Medicare Advantage appeals if your care is ending
If you are receiving care from a hospital, skilled nursing facility (SNF), Comprehensive Outpatient Rehabilitation Facility (CORF), hospice, or home health agency and are told that your Medicare Advantage Plan will no longer pay for your care (meaning that you will be discharged), you have the right to a fast
Explanation of Benefits (EOB)
An Explanation of Benefits (EOB) is the notice that your Medicare Advantage Plan or Part D prescription drug plan typically sends you after you receive medical services or items. You only receive an EOB if you have Medicare Advantage or Part D. An EOB is not the same as a
Medicare Advantage post-service standard appeals
If you have a Medicare Advantage Plan and were denied coverage for a health service or item that you have already received, you may choose to appeal to ask your plan to reconsider its decision. Follow the steps below if you think the denied health service or item should be
Medicare Advantage pre-service standard appeals
If you have a Medicare Advantage Plan and you were denied coverage for a health service or item before you received the service or item, you can appeal to ask your plan to reconsider its decision. Follow the steps below if you feel that the denied health service or item