Resolving Complex Medicare Problems

Helpline counselors answer thousands of questions each year on Medicare Rights’ free national helpline, and some Medicare questions require more than one call to resolve. Staff and volunteers work to empower helpline clients with comprehensive counseling and educational materials; when they hear from callers with more complex problems, they refer them to Medicare Rights’ general casework staff. 

Through casework, Medicare Rights’ client services staff provide rigorous and relentless advocacy for people with Medicare—at no charge. Cases often involve conducting intensive research to locate specific Medicare rules, sorting through medical bills and explanations of benefits, making phone calls to physicians’ offices and insurance companies, and brainstorming strategies to find a solution. 

“Our number one goal, of course, is to help the person in front of us,” says Jake McDonald, client services counsel and supervisor of Medicare Rights’ casework. “But we also use casework to give ourselves on-the-ground experience that will help improve our counseling and educational materials for everyone.” 

Complex Medicare cases span a wide range of issues, with many related to Medicare enrollment or a private plan’s denial of a health care service.  

For example, Medicare Rights often hears from older adults and people with disabilities who did not enroll timely in Medicare Part B when they were first eligible due to being misinformed. This can lead to harmful gaps in health coverage and costly, lifetime late enrollment penalties. Casework staff identify strategies to help people enroll and troubleshoot enrollment delays and other issues.  

Other clients contact Medicare Rights when they have been denied the care they need, and casework staff work with them to appeal unfavorable coverage decisions. Staff help clients request coverage of the service by drafting appeal letters, collecting supporting documents, and communicating with providers. 

Regardless of the Medicare issue facing a client, Medicare Rights’ casework staff work diligently to resolve it, building on the over 30 years of experience the organization has helping people with Medicare.