Office of Medicare Hearings and Appeals (OMHA)
There are four distinct health insurance programs within the Medicare program and each has its own appeals process. These health insurance programs are referred to as "parts." It is important that you know under what part of the Medicare program you received medical services or items in order to appeal a decision regarding those benefits.
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Descriptionof Parts of Medicare
Parts A & B or “Original Medicare” includes Hospital Insurance (Part A) and Supplementary Medical Insurance (Part B).
Hospital insurance (Part A) helps pay for inpatient care in a hospital or skilled nursing facility (following a hospital stay), some home health care and hospice care.
Medical insurance (Part B) helps pay for doctors’ services and many other medical services and supplies that are not covered by hospital insurance.
Part C is the Medicare Advantage Plan program.Under the Medicare Advantage program (Part C), Medicare Advantage plans are available in many areas. Beneficiaries with Medicare Parts A and B can choose to receive all of their health care services through one of these Medicare Advantage plans under Part C.
Part D is the Medicare Prescription Drug program
Prescription drug coverage (Part D) helps pay for certain medications doctors prescribe for treatment. Beneficiaries obtain prescription drugs through Medicare Prescription Drug Plans.
Please note that the Office of Medicare Hearings and Appeals is responsible only for the Level 3 claims appeals and certain Medicare entitlements and Part B Premium appeals. OMHA is not responsible for levels 1, 2, 4, and 5 of the appeals process. OMHA provides additional information on other levels of appeals to help you understand the appeals process in a broad context.