Topic

Medicare & Medicaid

Enrollment, dual eligibility, Part D, Medicaid managed care, fair hearings, and long-term supports—nested under Insurance so you can move from private plans to public programs in one topic.

10 guides on Medicare and Medicaid coverage and appeals

Start here

Orient to Medicare and Medicaid, then open the guide that matches the patient’s card, program, and problem.

Medicare BasicsParts A, B, C, D, enrollment, coverage categories, and common patient confusion points.Medicaid BasicsEligibility, benefits, state administration, managed care, renewals, and common coverage issues.Dual-Eligible PatientsAdvocacy for patients with both Medicare and Medicaid.

Medicare

How federal Medicare works by coverage type—Original Medicare, Advantage, Part D, and supplements—and what to do when care is denied.

Original MedicareHow traditional Medicare works, including providers, claims, and supplemental coverage.Medicare AdvantageMedicare Part C—how private plans deliver Medicare, CMS oversight, networks, and Medicare appeals when care is denied.Medicare Part D Prescription CoverageFormularies, coverage determinations, exceptions, redeterminations, and appeals.Medicare Appeals & GrievancesMedicare appeal levels, expedited reviews, grievances, and how Part D drug appeals fit the same ladder.

Medicaid

State Medicaid programs, managed care vs fee-for-service, eligibility, fair hearings, and long-term care supports.

Medicaid Managed CareWhen Medicaid benefits run through an MCO—grievances, plan appeals, fair hearings, and keeping services during appeal.Medicaid Fee-for-ServiceWhen the state pays providers directly without an MCO—how coverage works, disputes, and state fair hearings.

State guides & updates

State agency links and program news.

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