The Medicare Insurance Lady

Celebrating since 2008 as a Medicare Insurance Specialist

(This Is NOT A Government Newsletter)

📧 tcangemi@RetirementHPMS.com

Hi there!

MESSAGE TO CLIENTS:

I hope my newsletter finds you all well :)

MEDICARE SECTION:t

HOW & WHEN TO FILE A MEDICARE APPEAL WHEN A CLAIM IS DENIED.

If you received a notice saying Medicare denied payment, you have the right to appeal.

An appeal is a formal request you make if you disagree with a coverage or payment decision.  

Always check your Medicare Summary Notice (MSN) to see if Medicare has paid for your services and how much you may owe your provider. If your MSN says that Medicare did not pay for a service, and you think it should, call your doctor to make sure there was not a billing error before appealing. 

Start your appeal by following the appeal instructions listed on your MSN or Redetermination Request form: 

• Circle the denied service listed and filling out the shaded section at the end of the MSN.  
• Send your appeal to the Medicare Administrative Contractor (MAC) within 120 days of the date on your MSN. (The MAC’s name and address are listed in the shaded section of your MSN.)  
• This will start your appeal process. The MAC should make a decision within 60 days. 

If your provider sends you a bill for this service, let your provider’s billing office know that you are in the process of appealing Medicare’s coverage decision. 

If your appeal is successful, your service or item will be covered. If your appeal is denied, you can move on to by appealing to the Qualified Independent Contractor (QIC) within 180 days of the date listed on the MAC denial letter.  

The Qualified Independent Contractor (QIC) may go by a different name in your area.

Follow the instructions on the Medicare Administrative Contractor (MAC) denial notice to file your appeal. The QIC should make a decision within 60 days. 

If your QIC appeal is successful, your service or item will be covered. If your appeal is denied and your health service or item is worth at least $200 in 2026, you can choose to appeal to the Office of Medicare Hearings and Appeals (OMHA) level.  

Follow the appeal deadlines. If you have a good reason for missing your appeal deadline, you may be eligible for a good cause extension. You should also keep a copy of all documents sent and received during the process. 

(This article is taken from the Medicare Rights Center, Dear Marci newsletter; May 2026)

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HEALTH SECTION:

EPIC PROGRAM

The Elderly Pharmaceutical Insurance Coverage (EPIC) program is a New York State program for seniors administered by the Department of Health.

• It helps income-eligibles aged 65 and older to supplement their out-of-pocket Medicare Part D drug plan costs.
• 
  Those who qualify can apply for EPIC at any time of the year and must be enrolled or eligible to be enrolled in a Medicare Part D drug plan to receive EPIC benefits and maintain coverage.
• 
  
• EPIC provides secondary coverage for Medicare Part D and EPIC-covered drugs purchased after any Medicare Part D deductible is met.
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• EPIC also covers approved Part D-excluded drugs once a member is enrolled in Part D.
• 
  
• EPIC helps pay the Medicare Part D drug plan premiums for members with income up to $23,000 if single or $29,000 if married.
• 
  
• Higher income members are required to pay their own Part D premiums but EPIC provides premium assistance by lowering their EPIC deductible.
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• EPIC has two plans based on income. The Fee Plan is for members with income up to $20,000 if single or $26,000 if married.
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• The Deductible Plan is for members with incomes ranging from $20,001 to $75,000 if single or $26,001 to $100,000 if married.
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• It is easy to join the program. Just complete the application and mail/fax it to EPIC or apply online.

EPIC also offers an enrollment period one time per year when you are in a Medicare "Lock-In" period. Another words, outside the Annual Enrollment Period. Even if you don't use the EPIC benefits, but still apply, you can use your EPIC ID # towards changing your Medicare insurance plan.

No documentation is required.

EPIC verifies information with the Social Security Administration and the New York State Department of Taxation and Finance.

Are you looking for more dental and vision coverage?

You can enroll in a OTHER DENTAL COVERAGE - STAND ALONE plans, for additional monthly premium.

Go to my website: www.RetirementHealthPlansMadeSimple.com

(FIND: "Quote Tools" tab). 

You can enroll in dental and/or vision coverage, on my website online. If you enroll online (on my website), I will get paid a commission for your enrollment.

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