For personal help with questions or problems with Medicare, people 60 or older can contact their local Senior Health Insurance Assistance Program ("SHIP")

• Part A, Hospital Insurance,  is controlled by the federal regulations at 42 CFR Part 409.  Part A pays for care in hospitals and some care in nursing homes.  Part A is explained in simple terms on the Medicare web site.
• Part B, Supplemental Medical Insurance, is controlled by the regulations at 42 CFR Part 410. Part B pays for doctor's bills, lab and x-ray services, durable medical equipment (such as wheelchairs), and other services. Part B is explained in simple terms on the Medicare web site.
• Hospice Care for terminally ill persons, is controlled by 42 CFR Part 418.
• Part C - Medicare Advantage
• Part D - Drug coverage - new benefit as of January, 2004. Am I eligible? (AARP).  The Medicare Advocacy Center has a list of Frequently Asked Questions concerning Medicare Part D.  Additionally, the U.S. Department of Health and Human Services host the Center for Medicare and Medicaid Services which has an extensive amount of information.

Medicare payment for medical treatment is subject to annual deductibles, co-payments, and other conditions. 2007 Medicare deductibles and co-pays.

Also see information on the Medicare Prescription Drug Benefit.

• You can appeal any denial, termination, or reduction of benefits
• You must file an appeal within 60 days of the date of the written notice you disagree with
• Reconsideration - Generally, you probably do NOT need a lawyer at this stage.  You can file this appeal yourself, or you may be able to get help from the Senior Health Insurance Assistance Program.
• Hearing before an Social Security Administrative Law Judge. The chances of a successful appeal are much better at this stage if you are represented by a lawyer.  This is the only opportunity to testify and to have other witnesses testify.  Generally, all of your evidence, paper records or testimony of witnesses should be submitted by this stage.
• Social Security Appeals Council This appeal is a review of the file.  There is no hearing at this stage.
• U.S. District Court  The court makes a very limited review of the case.  It looks only at whether there are "errors of law" and whether the decision is reasonable ("supported by substantial evidence").

Medicare appeals can be complicated. You should consider getting legal help if you have a problem with Medicare coverage or payment decisions.

• Discounted medication through the Maryland Pharmacy Discount Program.
• Help from the patient assistance programs run by various private drug manufacturers.
• Part A deductibles and co-payments are paid by Medical Assistance or the Qualified Medicare Beneficiary program if you are eligible for either of them.
• Part B of Medicare requires payment of a monthly premium, which usually is deducted from your Social Security check.  If you are also eligible for Medical Assistance, it pays the Medicare Part B premiums.  See also Qualified Medicare Beneficiary and Special Low Income Medicare Beneficiary, which are programs that pay all or part of the Part B premiums.

Federal Law: 42 U.S.C. § 1395 to 1395gg The Medicare law is also referred to as Title XVIII of the Social Security Act.

Federal Regulations:  The core Medicare regulations are at  42 C.F.R. Parts 400 to 424 and 460-498

• Part A  is controlled by the federal regulations at 42 CFR Part 409.
• Part B  is controlled by the regulations at 42 CFR Part 410.
• Hospice Care for terminally ill persons, is controlled by 42 CFR Part 418.

Federal Policy Materials: The Department of Health and Human Services (through the Centers for Medicare and Medicaid Services - CMS) publishes informal guidelines that are widely used and often binding on intermediaries and carriers at the first level of decision-making. When you appeal your case, you should know that the guidelines are "advisory only". Administrative law judges or the Appeals Council are not required to follow these guidelines.

• Centers for Medicare & Medicaid Services  published a helpful booklet entitled "Medicaid and You 2009" -  For more help with Adobe Acrobat Reader.
• Medicare Benefits 2008 (Part A and Part B)
• Medicare and Home Health Care - A detailed description of Medicare coverage of home health care.  From the US Government Consumer Information Center in Pueblo, Colorado. Note:  This page will load slowly on your computer; give it a while.
• Medicare Hospice Benefits - "Hospice is a special way of caring for people who are terminally ill, and for their family. This care includes physical care and counseling. Hospice care is given by a public agency or private company approved by Medicare. It is for all age groups, including children, adults, and the elderly during their final stages of life. The goal of hospice is to care for you and your family, not to cure your illness." For more help with Adobe Acrobat Reader.

Last legal review 10/17/08 (PLL/M.A.J.)

About this website. The Maryland State Law Library, a court-related agency of the Maryland Judiciary, sponsors this site. The website was developed (1999-2007) as part of an access to justice initiative by the Maryland Legal Assistance Network (MLAN) in collaboration with a number of legal services providers serving low and moderate income Marylanders.  In the absence of file-specific attribution or copyright, the Maryland State Law Library may hold the copyright to parts of this website. You are free to copy the information for your own use or for other non-commercial purposes with the following language “Source: Maryland's People’s Law Library – www.peoples-law.org. © Maryland State Law Library, 2007.”

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