1-800-MEDICARE: The Medicare Helpline

If you have questions about claims, coverage and payments, one of the resources available is the Medicare helpline: 1-800-Medicare. This federal helpline is designed to help you navigate your coverage, one phone call at a time. We are going to take a closer look at the Medicare helpline, including how to get ahold of specific departments, to ensure you have a positive experience.

What is the Medicare helpline?

The Medicare helpline, 1-800-Medicare (1-800-633-4227), is the official Medicare phone number. It allows Medicare beneficiaries to call for help 24/7 (except for some federal holidays) in both English and Spanish. They even have a special line for the hearing impaired (the TTY Medicare toll-free line is 1-877-486-2048).

Calling 1-800-MEDICARE

When you call the Medicare helpline, you will be greeted by an automated welcome. You will be asked to give a brief explanation of what you are calling about. Remember to speak clearly to help the automated system best direct your call. Here’s some examples of what you might say:

• To check on a claim status, you can ask for “claims” or “claim status.”
• Got coverage or benefit questions? Ask for “coverage and benefits.”
• To review premium information, ask for “premium payments” or “premiums.”
• Want to check your deductible? Ask for “deductible.”
• To learn more about preventive exams, ask for “preventive exams.”
• If your question is not among those common examples, saying “something else” can help get you more specialized direction.
• You can also ask to speak directly with a Medicare agent at any time.

Not sure what to ask? Not a problem! Let’s take a closer look at what each of those answers can help you access and where else you can find that information if you don’t have time for a phone call.

Claims

If you are calling 1-800-MEDICARE about a claim, you might be asking about a claim status or trying to determine why a claim was denied. And while sometimes you just need to talk to a person to get additional information, it’s important to remember you can always check claims online using your MyMedicare.gov account.

MyMedicare.gov is a free account you can sign up for as a Medicare beneficiary that helps you access:

• The claim status of any Medicare Part A or Part B claim, usually within 24 hours of the claim being processed
• Your Medicare Summary Notice (MSN), which shows all your Medicare coverage and billing activity for the previous 90 days
• A downloadable printout of your Medicare Part A and Part B claim information

Note: Information about claims filed for Medicare Advantage plans or Medicare Part D drug plans will not be on MyMedicare.gov, since that coverage is offered by private providers. See your plan information for more details on claim information.

Coverage and benefit information

Original Medicare, or Medicare Part A and Part B, cover a wide variety of health services. Many beneficiaries call 1-800-MEDICARE with questions about whether a specific service or treatment is covered by Medicare.

If you don’t have time to make a call about your coverage, you’re in luck. Medicare has put a list of covered health services online. You can visit the “Your Medicare Coverage” page to search for the test, item or service in question to determine if something is covered by Original Medicare.

For coverage questions on purchased plans, such as Part D plans and Medicare Advantage plans, please reach out to your plan provider.

Premium payments and information

Medicare premiums can feel confusing because there are a lot of variables that go into how much you’ll end up paying. While talking to a Medicare agent certainly can help clear up confusion, here are a few things you’ll need to remember when trying to understand Medicare premiums:

Part A premiums only apply if you do not fit into at least one of these categories:

• You’ve worked for 40 quarters (10 years) and have paid Medicare taxes on that income
• You are eligible to receive retirement benefits from Social Security or the Railroad Retirement Board
• You (or your spouse) worked in Medicare-covered government employment
• You receive disability benefits or have end-stage renal disease (ESRD) and meet certain criteria

Those who do not meet those requirements may have to pay up to $506 per month for Part A premiums, depending on work history and Social Security.

Everyone, regardless of work history, pays a Part B premium fee. In 2023, the standard premium is $164.90, although those with higher incomes pay a higher premium.

Part D and Medicare Advantage premium amounts can be found in your plan information.

Deductible

One of the reasons you might call the Medicare helpline is to ask about your deductible and to determine if your Medicare deductibles have been met.

Medicare has two deductibles: one for Part A and one for Part B. The Part A deductible does not operate on a yearly basis, instead using benefit periods which can reset throughout the year. The Part A deductible is $1,600 per benefit period in 2023. The Part B deductible does reset with each calendar year and is $226 in 2023.

Medicare Advantage and Part D deductibles may vary based on the plan and are subject to annual changes.

Preventive exams

While Original Medicare covers a wide selection of preventive exams and tests, you may want to determine if the one you need is covered. Talking to an agent can help you better determine if you meet eligibility criteria (if required) and if the exam is covered.

Another way to learn about covered exams is to use the Medicare coverage finder to search for the desired test or examination. We also have a post all about Preventive Screenings right here on our Learning Center to help you learn more about the services available.

Conclusion

1-800-MEDICARE is a fantastic resource for Medicare users to check on claims, coverage, deductibles and more. However, because it has so many options to choose from, it can also be confusing. Knowing how to navigate the helpline as well as where else information is available without having to make a call can help you better manage your coverage and prepare for future care.

And if you have any questions about Medicare plans, including how to get a Part D Drug plan, please feel free to reach out – we will be happy to help you.

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