Filing a complaint
If you have concerns about the quality of your care or other services, you can file a complaint (also called a "grievance").
Should I file a complaint or an appeal?
File a complaint if:
- You have a problem with the quality of the care you got or are getting
- You have a problem with how you’re being treated by your plans
File an appeal if:
- You have an issue with a plans’ refusal to cover a service, supply, or prescription.
- You got a bill for a claim you already submitted.
- Learn more about appeals.
How do I file a complaint?
My Medicare health or drug plan
Examples: Customer service issues, problems with access to specialist, or a problem with an appeal
Use the Medicare Complaint Form or follow the instructions in your plan membership materials to submit a complaint about your Medicare health or drug plan. Generally, you can find your plan's contact information on your plan membership card.
What else do I need to know about filing a complaint about my Medicare health or drug plan?
Improper care or unsafe conditions
Example: Abuse of a nursing home resident or water damage in a health care facility
The State Survey Agency is usually part of your State’s health department.
Hospital conditions
Example: Poor housekeeping in a hospital or rooms being too hot or cold
Your doctor or health care provider
Example: Licensing questions or unprofessional conduct
Kidney care
Example: Unclean dialysis center
Your quality of care by any provider in any setting
- Not getting treatment when you got abnormal test results
- Being sent home from the hospital when you’re still in severe pain
- Being sent home from the hospital without clear instructions on how to maintain your care
- Drug errors
- Unnecessary or inappropriate surgeries or treatments
Contact your supplier or call us at 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
Once you file your complaint, your supplier must:
- Let you know they got your complaint and are investigating it within 5 calendar days.
- Send you the result of your complaint and their response in writing within 14 calendar days.
Can I file a complaint anonymously?
Yes, you can file a complaint anonymously. The method for filing a complaint anonymously will also depend on what type of complaint you are filing, so refer to the contacts above for more information.
Can I get help filing a complaint?
- State Health Insurance Assistance Program (SHIP): Visit shiphelp.org to get the phone number for your local SHIP and get free, personalized health insurance counseling. SHIPs are state programs that get money from the federal government to give free local health insurance counseling to people with Medicare.
- Medicare: You can also contact us for help. Talk or live chat with a real person, 24 hours a day, 7 days week (except some federal holidays) by calling 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
- Representative: If you have a family member or friend helping you with a complaint, you can appoint them as a representative. How do I appoint a representative?
