- A complaint about the way a beneficiary’s Medicare health plan or Medicare drug plan is giving care. For example, a beneficiary may file a grievance if they have a problem calling the plan or if they are unhappy with the way a staff person at the plan has behaved toward them. However, if a beneficiary has a complaint about a plan’s refusal to cover a service, supply, or prescription, they need to file an appeal.
- If a Medicare beneficiary has a grievance about the care or services received, they have the right to file a grievance with their Medicare plan. To file a grievance, a beneficiary will need to contact their Medicare plan and explain the issue they are concerned about. The beneficiary’s Medicare plan is required to investigate the grievance and provide a written response.
- It is important to note that Medicare grievances are different from Medicare appeals, which are requests for Medicare to review a decision that has been made about a beneficiary’s coverage or payment for a service or item. If the beneficiary is dissatisfied with a decision that has been made by their Medicare plan and they believe that the decision is incorrect, an appeal may be filed instead of a grievance.
- If a beneficiary has any questions about filing a Medicare grievance or about their Medicare coverage or benefits, it is recommended that to contact the Medicare plan or speak with a Medicare representative. The beneficiary may also want to discuss their concerns with their healthcare provider to ensure that they understand their treatment options and any potential out-of-pocket costs.
