A Medicare specialist is someone who has a thorough understanding of Medicare, a government-sponsored health-care program for Americans. Occasionally, he or she is referred to as a Medicare consultant. A person like this might work in a private insurance company’s medical billing or medical coding department, which is a designated Medicare claim processor.
A Medicare specialist who answers questions about coverage for beneficiaries understands coverage for physician services, hospitalization, prescription medications, and durable medical equipment under Medicare. The national medical insurance for retirees, those with end-stage renal disease or kidney failure, and those who have received disability payments for a two-year period does not cover 100% of healthcare costs. When looking for additional medical coverage, beneficiaries frequently seek the advice of a Medicare specialist to help them understand their options.
Questions about Medicare fraud can also be directed to a Medicare specialist, who is familiar enough with the program to know what actions by doctors or hospitals should be investigated. The specialist may or may not be in charge of the investigation, but he or she knows how to ask the beneficiary enough questions to make a referral to the appropriate office. A Medicare specialist is a customer service representative who works in a call center and represents the government insurance to beneficiaries over the phone.
This person can also answer questions about national insurance eligibility and automatic enrollment, which occurs under certain circumstances. A Medicare specialist is usually knowledgeable about the various types of preventative medical care that a person should receive to help reduce the need for long-term or intensive medical treatment. A Medicare specialist may inform beneficiaries about tests that the insurance covers. Other questions answered by specialists include those about automatic premium deductions from a person’s Social Security check, special programs for low-income beneficiaries in need of assistance with premiums, co-payments, and deductibles, as well as questions about beneficiaries’ choices of doctors and hospitals.
Some specialists work or volunteer as consultants at senior community centers so that they can help clients understand the brochures and charts comparing Medicare supplement medical plans in person. They also assist people in taking the steps necessary to obtain a second or even third opinion, which is covered by Medicare, before accepting treatments for a diagnosis. Complaints about the handling of beneficiaries’ medical records can also be shared with a Medicare specialist, who can help patients file an official complaint or navigate the appeals process if coverage is denied.