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More Resources: FAQs About Your Plan

Question 5: What if I have a Complaint about my Prescription Drug Plan?

You have a right to file complaints about your plan that are not related to appealing for coverage or payment for a drug. You should file your complaint (called a grievance) within 60 days of whatever led to your dissatisfaction. Some examples of complaints you might have include:

• Waiting on hold for too long when you call your plan.
• Getting “junk mail” from your drug plan about other products that the company offers.
• Not getting a decision on a request for coverage within the required time frame.
• Not getting notices about things the plan is required to tell you about, for example, if a medicine is removed from the formulary.

To file a complaint, you may either call or write to your plan. The plan is required to have a process to hear and resolve your grievance. They must tell you their decision within 30 days regarding of when you make your complaint. Plans must keep records of all grievances, which are reviewed by the federal government when they evaluate the plans.

You may also file a complaint with the office of the Medicare ombudsman. This office is responsible for assisting you with grievances, as well as appeals. The Medicare ombudsman’s office can be reached at 1-800-MEDICARE (1-800-633-4227) or online at http://www.cms.hhs.gov/center/ombudsman.asp.