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The Medicare Beneficiary Ombudsman protects your rights as a health plan beneficiary

What Is a Medicare Beneficiary Ombudsman and How Can They Help Me?

Congress created the Medicare Beneficiary Ombudsman in 2003 to advocate for Medicare beneficiaries’ rights and protections. It helps them with their information requests, appeals, complaints, inquiries, and grievances. The creation of the Medicare beneficiary Ombudsman (MBO) comes in handy. No matter how stuck you are, they can resolve your concerns about Medicare.

If you qualify for Medicare, The Medicare Family can come in handy. We will explain to you how Medicare works and show you all the options available to you. Furthermore, if you already qualify or are about to qualify for Medicare, you must know all about MBO.

What Is a Medicare Beneficiary Ombudsman?

Medicare is an insurance plan that the federal government created for individuals who are 65 and above. It is also available for anyone with End-Stage Renal Disease and disabled youth. Anyone qualified to receive Medicare also has a right to the MBO services.

Some individuals have Medicare but also get Medicaid if they are eligible. The Medicare Savings Program assists eligible individuals with Medicare costs. Seniors with low income can receive the benefits of the Medicare Savings Program.

The MBO also comes in handy in answering questions about your Medicare. It does not matter whether you have a middle or low income. The Medicare Beneficiary Ombudsman protects your rights as a health plan beneficiary. Also, if you experience a violation of Medicare rights, it helps resolve the issue.  

One essential person to get in touch with when dealing with Medicare issues is a Medicare Ombudsman. A Medicare Ombudsman is responsible for assisting Medicare beneficiaries in getting the aid they need if there are issues with the coverage.

If you have any inquiries or concerns with Medicare, getting the help of an ombudsman is an essential step that you should take.

Congress charged the Medicare Beneficiary Ombudsman with the duty of carrying out administrative and customer service efforts. They respond and receive complaints and inquiries from the beneficiaries and key stakeholders.

The Medicare assistance program works with other partners to offer education and outreach to beneficiaries. Thus, if you want to know more about Medicare, you can always contact an MBO to receive the necessary education. The Medicare Beneficiary Ombudsman ensures that you can:

  • Get Medicare concerns resolved.
  • Understand your protections and rights concerning Medicare.
  • Make the best health care decisions.

MBO also ensures that Congress and other healthcare entities know what works and does not. Thus, it plays a crucial role in enhancing the quality of care and services you will receive via Medicare. Some of the information they use comes from beneficiary feedback.

Protections and Rights as a Medicare Beneficiary

What are Your Protections and Rights as a Medicare Beneficiary?

You have some basic rights if you have Medicare or qualify for it; they include:

  • Privacy protection
  • Unethical practices protection
  • Ensures you receive the health care services that you need
  • Protection when receiving healthcare

What to Do If You Have a Question?

  • Contact us. We have been around since the 1980s, helping seniors and youths with disabilities to navigate Medicare. Most seniors have trouble understanding the insurance plan, which is why we are here to help. We ensure that you can understand Medicare in simple terms and can also answer any questions about your plan.
  • Call 1-800-633-4227: The contact number is useful if your plan cannot resolve your concern. You can also call 1-800-MEDICARE for further assistance.
  • Contact the Medicare Beneficiary Ombudsman: You can always ask the representative available at 1-800-MEDICARE to submit your inquiry or complaint to the MBO. The Medical Ombudsman will ensure that your concerns get resolved.
MBO Assistance

How to Get the MBO Assistance?

MBO has partnerships with the State Health Insurance Assistance Programs (SHIPs). The programs offer free health insurance education and counseling to individuals with Medicare. It also works with advocacy organizations that resolve your Medicare concerns. The MBO offers assistance, counseling, and information regarding:

  • Medicare grievances
  • Medicare inquiries about premiums, coverage, and benefits
  • Concerns about Medicare Prescription Drug Plan
  • Appeals in case you disagree with Medicare’s payment and coverage decisions
  • Concerns about leaving or joining the Medicare Advantage Plan such as PPO or HMO
  • Appeals about your Medicare Plan
  • Issues with Medicare Healthcare Plan

Who is a Competitive Acquisition Ombudsman (CAO)?

The CAOs are Ombudsman that will help you resolve Medicare issues in areas such as:

  • Orthotics
  • Prosthetics
  • Durable medical equipment
  • Supplies

The CAO comes in handy if you have any concerns about your supplies or equipment. The CAO ensures to resolve your issues, especially when you have trouble accessing your durable medical equipment. The CAO involves the competitive bidding program of Medicare. 

If the CAO does not resolve your issue with the supplier, you can always contact 1-800-MEDICARE. Then, you can ask the representative to forward your complaint or question to CAO. The Competitive Acquisition Ombudsman will respond to your issue and questions and ensure that they settle all your Medicare questions.

The Medicare Family has been around since the 1980s. It has helped seniors with Medicare throughout its existence. Contact us today if you have any inquiries about the Medicare process or the medical Beneficiary Ombudsman.

Sylvia Gordon, aka Medicare Mama®, is an expert on all things Medicare and Social Security. She is the 2nd Generation here at The Medicare Family and has served on the advisory boards of major insurance companies like UnitedHealthcare®, Cigna, and Anthem. In her free time, she can be found taking care of her animals (dogs, goats, peacocks, chickens), and reading a good book. Learn More.
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