Like private insurance, Medicare and Medicaid have appeal options
Like people with private group and individual health plans, anyone with Medicare and Medicaid has the right to appeal coverage decisions.
Visit the Medicare website or call 1-800-MEDICARE (1-800-633-4227) to learn more about what Medicare covers and how to manage claims and appeals.
Each state manages its Medicaid program independently. If you have questions or concerns about your Medicaid benefits or coverage, contact your state program.
Medicaid is a public health program, and may not be required to abide by all of the Patient Protection and Affordable Care Act (ACA) rules. If you qualify for Medicaid based on your state’s decision to expand Medicaid under the ACA you are entitled to the same screening and preventive services as people who are covered by private insurance. If you who qualify based on other traditional Medicaid eligibility pathways, cancer screening and preventive services are considered “optional” and the scope of coverage is determined by the state. For more details, visit healthcare.gov.
- Visit the How to Get Testing section of our website for information about genetic testing and finding a cancer genetics expert.
- The Assembling Your Care Team section of our website has information on identifying qualified health care professionals to help manage your care.
- See the Risk Management Guidelines for expert medical recommendations on genetic testing, high-risk screening and preventive interventions as these vary for different hereditary mutations.