Federal Medicare Resources

Rachel B Morgan RN, BSN 4/7/2014

Medicare signMedicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). Here are some of the online resources to help navigate issues associated with Medicare coverage.

Web Resource

Issues Addressed

Information Covered

Centers for Medicare and Medicaid Services (CMS)

Medicare Program | General Information

This overview page provides important information on CMS policy with respect to PAPs, and also provides some helpful links to other information contained on the Office of the Inspector General's website. 

Policy Memos to States and Regions

CMS Survey and Certification memoranda, guidance, clarifications and instrutctions to State Survey Agencies and CMS Regional Offices

Frequently Asked Questions

Contains answers by category to the most frequently asked questions regarding the Medicare program. Allows direct submission of Medicare questions to CMS support staff.  

Medicare Coverage Database

The Medicare Coverage Database (MCD) contains all national Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), local articles, and purposed NCD decisions. The database also includes several other types of National Coverage Analyses (NCAs), Coding Analyses for Labe (CALs), Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) proceedings, and Medicare coverage guidance documents.

The program's purpose is to identify efficient, effective and economical procedures for conducting background checks. The program will be administered by the CMS in consultation with the Department of Justice (DOJ) and the Federal Bureau of Investigation (FBI).

Pharmaceutical Manufacturer Patient Assistance Program Information

This overview page provides important information on CMS policy with respect to PAPs, and also provides some helpful links to other information contained on the Office of the Inspector General's website.

Fee Schedules - General Information

Spotlight Information for Fee-for -Service Providers

Survey & Certification

State Agency Contacts

Congressional Research Services (CRS) Reports Medicare Primer General information about the stucture of the Medicare program.
Medicare and the Affordable Care Act (ACA)

Medicare Provisions in the Patient Protection and Affordable Care Act (PPACA): Summary and Timeline ( Jan. 24, 2011)

Medicare.gov Getting help paying costs
  1. Medicaid
  2. Medicare Savings Program
  3. PACE
  4. Save on drug costs
  5. Programs for people who live in U.S. Territories
  6. Find your level of Extra help (Part D)
  7. Insure Kids Now
  8. Supplemental Security Income (SSI)
Claims and Appeals
  1. How do to file a complaint or grievance
  2. How to file an appeal
  3. Get Medicare forms
Forms, Help and Resources
Find health plan and provider information, publications, suppliers, and how to report fraud.
Physician Compare Physician Compare is a website that helps consumers search for information about hundreds of thousands of physicians and other health care professionals. 
Medicare Payment Advisotry Commission (MedPAC) Reports, Databook, Congressional Testimony, Contractor Reports, Medicare Basics and Payment Basics
The MedPAC is an independent congressional agency established to advise the U.S. Congress on issues affecting the Medicare program. The commission's statutory mandate is quite broad: In addition to advising the Congress on payments to private health plans participating in Medicare and providers in Medicare's traditional fee-for-service program, MedPAC is also tasked with analyzing access to care, quality of care and other issues affecting Medicare.
Data.medicare.gov Hospital Compare Data Set 
These data allow you to compare the quality of care at more than 4,000 Medicare-certified hospitals across the country.
Nursing Home Compare Data
These data allow you to compare the quality of care at every Medicare and Medicaid-certified nursing home in the country, including more than 15,000 nationwide.
Physician Compare Data

The Physician Compare National Downloadable file includes general information, such as demographic information and Medicare individual-level quality program participation. The Physician Quality Reporting System (PQRS) Group Practice Reporting Option (GPRO) and Accountable Care Organization (ACO) downloadable files provide program year 2012 measure performance rates for four Diabetes Mellitus (DM) and one Coronary Artery Disease (CAD) quality measures. Measure data are available for group practices of 25 or more eligible professionals and ACOs that reported via the GPRO web interface. For information about public reporting on Physician Compare visit the Physician Compare Initiative page.

Home Health Compare Data
These data allow you to compare the quality of care provided by Medicare-certified home health agencies throughout the nation.
Dialysis Compare Data
These data allow you to compare the quality of care provided in Medicare-certified dialysis facilities nationwide.
Supplier Directory

These are the official datasets used on the Medicare.gov Supplier Directory provided by CMS. They provide names, addresses and contact information for suppliers that provide services or products under the Medicare program.

Health data.gov Medicare Specific Data Sets