Medicare reference sources
Know where to verify the answer. A curated guide to the official agencies, plan documents, directories, formularies, notices, and local resources used to confirm Medicare facts.
The Library explains what information means. These sources help confirm what is current and specific to you.
This collection covers the official agencies, plan documents, directories, formularies, notices, and local resources used to confirm what is current and specific about a Medicare decision.
Start with what you need to confirm.
Pick the kind of fact you are checking, and go straight to the source that settles it.
When you can sign up, and whether a penalty applies.
What Part B and Part D cost at your income.
Copays, deductibles, and what a plan actually covers.
Whether a drug is covered, its tier, and its rules.
Whether a provider participates for the year.
How to read a notice and start an appeal.
Medigap rules and windows that vary by state.
Unbiased one-on-one help near you.
Federal sources.
The official record for eligibility, enrollment, premiums, and program rules.
The official consumer site for comparing plans, checking coverage, and finding providers.
- ✓ Plan and drug plan comparisons
- ✓ Whether a provider or supplier participates
- ✓ What Original Medicare covers
When it is not enough: Plan-specific details can lag the plan's own documents. Confirm the exact cost with the plan.
Visit Medicare.gov ↗Links open official government sites in a new tab. The Clearing is not affiliated with any government agency.
The agency that runs Medicare. The source for program rules, manuals, and official guidance.
- ✓ Program rules and regulations
- ✓ Annual figures and deductibles
- ✓ Official policy and guidance
When it is not enough: Written for administration, not consumers. Use it to confirm a rule, not to choose a plan.
Visit CMS.gov ↗Links open official government sites in a new tab. The Clearing is not affiliated with any government agency.
Handles Medicare enrollment, Part B premiums, and income-related premium adjustments (IRMAA).
- ✓ Enrollment and effective dates
- ✓ Your Part B premium and any IRMAA
- ✓ Requesting an IRMAA reconsideration
When it is not enough: Covers enrollment and premiums, not plan benefits or coverage decisions.
Visit SSA.gov ↗Links open official government sites in a new tab. The Clearing is not affiliated with any government agency.
Plan documents and notices.
Your plan is the controlling source for its own benefits, costs, and network. These are the documents where the details actually live.
The full legal description of what your plan covers, what it costs, and its rules. The controlling document for benefits.
A shorter overview of major benefits and costs, useful for a first comparison between plans.
What is changing in your current plan for next year: costs, benefits, and formulary changes.
The list of drugs the plan covers, their tiers, and restrictions such as prior authorization or step therapy.
Which doctors, hospitals, and pharmacies are in the plan's network for the year.
The plan's written explanation of a denied service or drug, and your appeal rights and deadlines.
A monthly summary of claims processed. Not a bill, but the record to check for errors.
State and local help.
Free, unbiased counseling and the offices that handle state-specific rights and protections.
State Health Insurance Assistance Programs offer free, unbiased one-on-one Medicare counseling.
Regulates insurance in your state and handles complaints about plans and agents.
Determines Medicaid eligibility and administers programs that help with Medicare costs.
Local hub for services for older adults, including benefits counseling and referrals.
State-run programs that help pay Part B premiums and other costs for those who qualify.
Some states add enrollment windows or guaranteed-issue rights beyond the federal minimum.
One source is not always the whole answer.
A single source can be right in general and wrong for your plan, your state, or this year. Confirming a Medicare fact usually means checking it in the source that actually controls it, then writing down what you found.
Identify which source actually decides this fact — the plan, the agency, or your state.
Check the specific number, date, or rule as it applies to you, not the general version.
Write down what you found and when. Rules and prices change through the year.
Flag anything a source could not settle, and who you still need to ask.
Clearing guides for using these sources.
Step-by-step help for turning an official source into a confirmed answer.
Official sources can still be general, out of date, incomplete, or hard to apply to one person’s situation. Treat time-sensitive and plan-specific facts as things to confirm directly, close to when you act, and keep a record of the date and the answer. The Clearing does not sell insurance, recommend plans, or provide medical, legal, or financial advice.
Found the source. Now apply it.
Reference sources confirm the facts. Decision Tools help you use them on your own situation.