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Medicare and Medicaid Help

Nearly one in every four Americans is enrolled in Medicare or Medicaid. These are the programs which provide health care for the aged, disabled, and indigent population administered by the Centers for Medicare and Medicaid Services (CMS). Because of its wide reach, trying to find the answers to your questions can often turn into a daunting experience.

So where does one begin the search for information for his/her needs? Here are some resources that you may find beneficial in your quest for knowledge and answers. Some of these are government resources while others are from third parties.

Medicare.gov, the Official U.S. Government Site for People with Medicare, is a good place to start. This site is written with the consumer in mind, and provides easy-to-use tools to help you find what you need. Among them are:For Medicare recepients who are researching whether a specific procedure is covered, there is the Coverage Issues Manual. The manual addresses coverages issues for clinical trials, medical procedures, supplies, diagnostic services, prosthetic devices, and nursing services.

Medicaid Expansion State by State discussion provided by Coverage Counts
Many low-income adults could gain access to Medicaid "a state-based health program" through a provision in the Affordable Care Act health reform law. Each state determines who is eligible for health care under Medicaid; in most states, people who qualify must have a low income and be under the age of 18, pregnant or have specific diseases. The health reform law gives each state the option to expand Medicaid coverage and include all people who earn less than 133 percent of the federal poverty level; Currently, the costs of Medicaid coverage are split evenly between states and the federal government. Under the expansion, the federal government will reimburse at least 90 percent of states' Medicaid costs.

Medicare Primer
This booklet is designed to familiarize individuals with the Medicare program with an emphasis on prescription coverage and utilization. The primer contains:
  1. An overview of the Medicare program, its growth over time, and its new structure under the Medicare Prescription Drug, Improvement & Modernization Act of 2003;
  2. A description of the most significant parts of the new Medicare prescription drug law.
The Center for Health Dispute Resolution (CHDR) operates the nation's largest system for the resolution of health insurance appeals through independent external review. The organization can help persons enrolled in a Medicare + Choice (Medicare HMO) plan when the company operating the plan decides to uphold its initial determination on the need of emergent or urgent services. These are services that the beneficiary feels should be covered by Medicare or by their plan, or any services the beneficiary believes should be provided by the plan. More information is available on their Medicare page.

NeedyMeds.com is an information resource where people can learn about patient assistance programs and other programs designed to help those who can't afford their medicines. The site includes an extensive list of drugs and programs, a comparison of pharmaceutical company discount card programs, and information on how to apply for patient assistance programs.

There are also resources here that may be beneficial to you in your quest for knowledge. They can be found in the Resources section or you may go directly to them by clicking the links below.
  • The Managed Care Answer Guide helps people make decisions about choosing a health care plan. It is also designed to assist consumers in understanding parts of their health care plan that may be confusing once they have made health insurance choices.
  • Your Guide to the Appeals Process features sample appeals letters, specific strategies to use when negotiating the internal and external appeals processes and specific instructions to follow when all appeals have been exhausted.
  • The State by State Financial Resource Guide contains information for patients seeking financial relief for a broad range of needs including housing, utilities, food, transportation to medical treatment, and children's resources.





National Coverage Analyses
Non-Autologous Blood Derived Products for Chronic Non-Healing Wounds
Posted proposed decision memorandum.


Medicare Approved Facilities
Carotid Artery Stenting Facilities List
New facilities added.