Medicare Snapshot: Stories from the Helpline

Managing Medicare Advantage Denials of Coverage and Appeals

Today, nearly 16 million seniors and people with disabilities are enrolled in an MA plan, representing 30 percent of the Medicare population. Many people with MA plans have a positive experience and report a favorable experience with their plan. Yet, we find that managing denials of coverage and appeals remains a consistent concern for MA enrollees, such as in Mr. W’s experience.

In 2013, we fielded over 15,000 questions from Medicare beneficiaries, family caregivers, and professionals. Many of our callers, like the one whose story is detailed in this brief, struggle to navigate the complexities of the Medicare Advantage system, secure coverage for needed services, and afford out-of-pocket health care costs.

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