Medicare Topics

Programs to Help You Pay

There are several different types of programs that can assist Medicare enrollees with their out-of-pocket costs for services. Here you can find some basic information about some of these programs, where to get more information and where to enroll in them.

Part D Extra Help*
For those with Medicare Part D making $18,456 or less yearly ($24,936 for married couples)* and meet certain resource limits.

Medicare Savings Programs*
Three programs for those earning $16,632 or less yearly ($22,464 for married couples)* and meet certain resource limits. Provides help with Medicare Advantage and Medicare Parts A, B, and D.

MO HealthNet*
Missouri’s Medicaid Program.


Other Drug Assistance Options

RxOutreach
A fully-licensed mail order pharmacy that is committed to making the use of prescription drugs safer and more affordable.

RxAssist
A comprehensive database of patient assistance programs, as well as practical tools, news, and articles that helps provide free medications to people who cannot afford to buy their medicine.

NeedyMeds
An information resource dedicated to helping people locate assistance programs to help them afford their medications and other healthcare costs.

Missouri Drug Card
As a resident of Missouri, you and your family have access to a statewide Prescription Assistance Program (PAP).


Other Programs

EyeCare America
EyeCare America is a public service program of The Foundation of the American Academy of Ophthalmology. It matches eligible seniors in need with volunteer ophthalmologists to provide a medical eye exam and up to one year of care with no out of pocket of the patient.


Choosing a Provider

It can be difficult to find health care providers like doctors, hospitals, or nursing facilities that meet your needs. Now, you can find all of Medicare’s resources to compare providers and plans in one place, Medicare’s Quality Care Finder, available at www.medicare.gov/qualitycarefinder. For help finding a long-term care provider, please visit www.longtermcare.gov.

Medicare Rights and Protections

No matter which plan you have, you have important rights in Medicare. Compared to most private health insurance, Medicare has some of the best consumer protections. Learn more in Your Medicare Rights and Protections, an official guide from the U.S. government. This booklet has important information about:

  • Your right to file a complaint
  • Your right to get health care services that you need
  • Where you can get help with your questions

Fraud and Abuse

Fraud typically occurs when Medicare is billed for treatments or other services (including supplies) never received by you, the patient. It is estimated that Medicare fraud costs Medicare millions each year.

Abuse typically occurs when healthcare providers fail to follow established medical practices. This failure can result in wasteful costs to Medicare, improper payments, or unnecessary and potentially harmful medical services. (Learn more)

CLAIM works with the SMP Program, which can help if you suspect you’ve been a target of Medicare errors, fraud, or abuse. Missouri’s SMP is run by Care Connection for Aging Services. To report errors, fraud, and abuse:

Call your plan provider. Discuss any questions you have and try to work out your concerns.

If you uncomfortable calling your provider or unsatisfied with the response, your SMP can be reached at 1-888-515-6565. You can also reach Care Connection for Aging Services directly by email at information@GoAging.org.

Discharge Appeals

If you believe you are being discharged too quickly from a hospital, you can request that the decision be reviewed by the state’s Medicare Quality Improvement Organization. In Missouri, KEPRO provides this discharge appeals service. If you wish to make an appeal, call KEPRO toll-free at (855)408-8557.

Quality of Care Concerns

If you are troubled by the quality of a Medicare service, call 1-800-Medicare (1-800-633-4227). In Missouri, you will be directed to call KEPRO. Experts at KEPRO will review your medical records to determine if your care met professional standards.

Examples of quality of care concerns you might report are:

  • Being given the wrong medication, or a medication to which you are allergic, or medications that interact in a negative way.
  • Not receiving treatment after abnormal test results.
  • Being given the wrong blood when a transfusion is ordered.
  • Sustaining a serious injury resulting from a fall while in a nursing home or hospital.
  • Being improperly evaluated for a problem and because of this you did not receive the treatment you needed.
  • Being given the wrong treatment or treatment that you did not need.
  • Developing bed sores because you were not moved regularly.
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