 How to contact the Medicare program and the 1-800-MEDICARE (TTY 1-877-486-2048) helpline
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. The CMS contracts with and regulates Medicare Health Plans (including Optimum HealthCare Inc.) 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. The TTY number is 1-877-486-2048 (you need special telephone equipment to use this number). 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. It includes booklets you can print directly from your computer. It has a tool to help you compare Medicare managed care 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.
SHINE—is an organization in Florida that provides health insurance assistance.
“SHIP” stands for State Health Insurance Assistance Program. SHINE ( Serving Health Insurance Needs of Elders) is the SHIP in Florida paid by the Federal Government to give free health insurance information and help to people with Medicare. SHINE can explain your Medicare rights and protections help you make complaints about care or treatment, and help straighten out problems with Medicare bills. SHINE has information about Medicare managed care plans and about Medigap (Medicare supplement insurance) policies. This includes information about special Medigap rights for people who have tried a Medicare Advantage plan (like Optimum HealthCare Inc.) for the first time. Section 12 has more information about your Medigap guaranteed issue rights.
You can contact SHINE at:
The Florida Department of Elder Affairs—SHINE Program
4040 Esplanade Way #280
Tallahassee, FL 32399
1-800-963-5337
elderaffairs.state.fl.us You can also find the website for SHINE at www.medicare.gov on the web.
Florida Medical Quality Assurance, Inc. (FMQAI)/Quality Improvement Organization – a group of doctors and health professionals in your state who review medical care and handle certain types of complaints from patients with Medicare
“QIO” stands for Quality Improvement Organization. The QIO is a group of doctors and other health care experts paid by the Federal Government to check on and help improve the care given to Medicare patients. There is a QIO in each state. QIOs have different names, depending on which state they are in. In Florida, the QIO is called Florida Medical Quality Assurance, Inc. (FMQAI). The doctors and other health experts in FMQAI review certain types of complaints made by Medicare patients. These include complaints about quality of care and complaints from Medicare patients who think the coverage for their hospital, skilled nursing facility, home health agency or comprehensive outpatient rehabilitation stay is ending too soon. See Section 10 for more information about complaints. You can contact FMQAI at 4350 W Cypress Street #900, Tampa, Florida 33607-4181 or at 1-800-844-0795.
Other organizations (including Medicaid, Social Security Administration) 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. 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.
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. The TTY number is 1-800-325-0778 (you need special telephone equipment to use this number). 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). The TTY number is 312-751-4701 (you need special telephone equipment to use this number). You can also visit www.rrb.gov on the web.
Employer (or “Group”) Coverage If you get your benefits from your current or former employer, or your spouse’s current or former employer, call Optimum’s Member Services if you have any questions about your benefits, plan premiums, or the open enrollment season.
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