Medicare & CMS
Medicare is the federal health insurance program for people 65 years of age or older, some people under age 65 with disabilities, and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant). CMS is the federal agency in charge of the Medicare program. CMS stands for Centers for Medicare & Medicaid Services. CMS contracts with and regulates Medicare Health Plans (including Central Health Medicare Plan) and Medicare Private Fee-for-Service organizations. Here are ways to get help and information about Medicare from CMS:
Call 1-800-MEDICARE (1-800-633-4227) to ask questions or get free information booklets from Medicare. You can call this national Medicare helpline 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048. Calls to these numbers are free.
Use a computer to look at www.medicare.gov, the official government website for Medicare information. This website gives you a lot of up-to-date information about Medicare and nursing homes and other current Medicare issues. It includes booklets you can print directly from your computer. It has tools to help you compare Medicare Advantage Plan and Prescription Drug Plans in your area. You can also search the “Helpful Contacts” section for the Medicare contacts in your state. If you do not have a computer, your local library or senior center may be able to help you visit this website using their computer.
Best Available Evidence (BAE)
CMS requires plans to establish the appropriate cost-sharing for low-income beneficiaries when presented with best available evidence (BAE) that the beneficiary's information is not accurate. For more information, visit
The Health Insurance Counseling and Advocacy Program (HICAP) – an organization in your state that provides free Medicare help and information.
The Health Insurance Counseling and Advocacy Program (HICAP) is a state organization paid by the federal government to give free health insurance information and help to people with Medicare. HICAP can explain your Medicare rights and protections, help you make complaints about care or treatment, and help straighten out problems with Medicare bills.
You can contact the Health Insurance Counseling and Advocacy Program (HICAP) at 1-800-434-0222. You can also find the website for HICAP at www.medicare.gov on the web.
Starting 8/1/14, Livanta is the new Medicare Quality Improvement Organization (QIO) that focuses on improving both patient care and health outcomes.
If you are discharged from hospitals, skilled nursing facilities, home health agencies or outpatient rehabilitation facilities, you have the right to appeal your discharge. Livanta is the designated group of practicing doctors and other health care experts who review all beneficiary discharge appeals to determine if covered services should be continued and if you should be allowed to stay in your health care setting. These appeals are processed by Livanta 24 hours a day, seven days a week and are based on medical record review, with a decision being rendered by a Livanta physician advisor in all cases.
You should contact Livanta in any of these situations:
- You have a complaint about the quality of care you have received.
- You think coverage for your hospital stay is ending too soon.
- You think coverage for your home health care, skilled nursing facility care, or Comprehensive Outpatient Rehabilitation Facility (CORF) services are ending too soon.
Contact information for Livanta is:
Livanta BFCC-QIO Program
10820 Guilford Road, Suite 202
Annapolis Junction, MD 20701
Toll-free Number: 877-588-1123
Fax number: 833-868-4063
Medicaid agency – a state government agency that handles health care programs for people with low incomes
Medicaid is a joint federal and state program that helps with medical costs for some people with low incomes and limited resources. Medi-Cal is the name for Medicaid in California. Some people with Medicare are also eligible for Medicaid. Most health care costs are covered if you qualify for both Medicare and Medicaid. Medicaid also has programs that can help pay for your Medicare premiums and other costs, if you qualify. To find out more about Medicaid and its programs, contact Medi-Cal at 1-800-541-5555.
Social Security Administration
The Social Security Administration provides economic protection for Americans of all ages. Social Security programs include retirement benefits, disability, family benefits, survivors’ benefits, and benefits for the aged, blind, and disabled. You can call the Social Security Administration at 1-800-772-1213. TTY users should call 1-800-325-0778. Calls to these numbers are free. You can also visit www.ssa.gov on the web.
Railroad Retirement Board
If you get benefits from the Railroad Retirement Board, you can call your local Railroad Retirement Board office or 1-800-808-0772 (calls to this number are free). TTY users should call 312-751-4701. You can also visit www.rrb.gov on the web.
Developed and maintained by The National Council on Aging (NCOA), BenefitsCheckUp is the nation's most comprehensive Web-based service to screen for benefits programs for seniors with limited income and resources.
The National Council on Aging (NCOA) is a nonprofit service and advocacy organization headquartered in Washington, DC. Their mission is to improve the lives of older Americans.
MAPRx is a coalition of patient, family caregiver and health professional organizations committed to safeguarding the well-being of patients with chronic diseases and disabilities under Medicare Prescription Drug Coverage.
The Center for Medicare Advocacy, Inc. is a national non profit, non-partisan organization that provides education, advocacy, and legal assistance to help elders and people with disabilities obtain Medicare and necessary health care.
The Medicare Rights Center (MRC) is a national not-for-profit consumer service organization that works to ensure access to affordable health care for older Americans and Americans with disabilities through counseling, educational programs and public policy initiatives.
AssistedLivingFacilities.org offers free information for assisted living in the United States. They list information on assisted living facilities and try to explain the rules and regulations of each state. They try to offer as much useful information as possible to help you decide if assisted living is a good option, and if so, to select the best facility possible.
AARP is a nonprofit organization for people ages 50 and over. Their website provides news and educational information on issues for that affect the 50+ Americans including healthier lifestyles.
SkilledNursingFacilities.org is a senior care resource that offers a nationwide directory of nursing homes. They provide detailed Medicare quality ratings, inspection information and filed complaints to help consumers research the best skilled nursing care options. They offer free information relevant to assist consumers during their senior healthcare search.
The Administration on Aging (AOA) is the principal agency of the U.S Department of Health and Human Services designated to carry out the provisions of the Older Americans Act of 1965 (OAA). The OAA promotes the well-being of older individuals by providing services and programs designed to help them live independently in their homes and communities. The Act also empowers the federal government to distribute funds to the states for supportive services for individuals over the age of 60. Learn more about Home & Community Based Long-Term Care, Wellness Programs, Nutrition and Health Promotion Programs, and Elder Rights Protection by visiting their website:
Adult day care centers are senior care locations that are open during normal business hours and typically provide social activities, meals and various health care services that can range from medication management to physical therapy. Adult day care locations may operate as stand-alone facilities, or may be located in nursing facilities, senior centers or other areas. Seniors generally attend adult day care on a scheduled basis which can provide relief to caretakers, such as family members or caregivers. Seniors who attend adult day care can benefit from the increased companionship and social interaction with others. AdultDayCare.org is a national resource for adult day care centers.
The National Long-Term Care Ombudsman Resource Center Long-term care ombudsmen are advocates for residents of nursing homes, board and care homes and assisted living facilities. Ombudsmen provide information about how to find a facility and what to do to get quality care. They are trained to resolve problems. If you want, the ombudsman can assist you with complaints. However, unless you give the ombudsman permission to share your concerns, these matters are kept confidential. Under the federal Older Americans Act, every state is required to have an Ombudsman Program that addresses complaints and advocates for improvements in the long-term care system. For more information, please visit their website:
Home health care companies offer a wide range of skilled medical services such as nursing care, physical therapy and occupational therapy from qualified medical professionals in addition to various services from home health aides. Other home care companies might offer assistance with daily activities, such as bathing and eating. Home care services are conducted in the comfort of your home. HomeHealthCareAgencies.com offers information on Medicare-certified home health agencies and other home care companies in the United States.