SPRINGFIELD — The Medicare system is complicated even for experts in the field, let alone a new enrollee choosing a plan.
Once Medicare enrollees get a plan, they may run into denial of coverage, prior authorization determinations or improper hospitalization discharge. These issues are common, longtime Medicare legal aid attorney Alice Bers said, but it is not as common for people to recognize denial of Medicare benefits as a legal issue.
“You shouldn’t need a lawyer to visit a doc or prevent a hospital visit from destroying their finances, but the sad reality is many people in the commonwealth do need a lawyer to sort through these issues,” Bers said.
The Medicare Advocacy Project fills this gap by providing legal aid to assist people ages 65 and older, as well as adults under 65 with disabilities, with their Medicare plans. While the statewide initiative began in the 1980s, the Massachusetts Legal Assistance Corp. provided Community Legal Aid, a nonprofit law organization, with funds to strengthen statewide outreach and training. Bers will head this coordination as director of the Medicare Advocacy Project in hopes of increasing awareness for Medicare-related legal services.
“Denial of Medicare benefits is common, but something that is not as common is for people to think of them as legal issues where an attorney or legal professional could assist,” Bers said. “They don’t need to navigate on their own.”
Health insurance headaches
Denial of Medicare benefits could look like a hospital discharge plan was not followed, the public or private Medicare provider denied a claim, or the provider’s prior authorization determination delays coverage. The appeals process for these decisions requires a lot of paperwork and deadlines, which can frustrate enrollees. This is where an attorney can help make sense of the determination and lead the appeals process, Bers explained.
“Something that people may not realize is how many different parts of Medicare there are, and how much more complicated it’s gotten just in the past 10 or 15 years,” Bers said. “People don’t realize the extent to which the Medicare program has become privatized.”
Right now, Medicare beneficiaries are wading through this complexity. Open enrollment for 2026 health insurance plans began on Oct. 15 and goes until Dec. 7.
More than half of all Medicare plans are run by private insurance companies, Bers said. Unlike original Medicare, which can be bolstered by supplementary plans, Medicare Advantage plans roll all benefits into one plan. However, there are trade-offs between both options, Bers said. If someone is eligible for Medicaid or veterans benefits as well as Medicare, enrollment quickly becomes unmanageable.
“It really is a very complex program,” Bers said.
Government-funded health insurance continues to change each year as well. The George W. Bush administration added the Medicare Part D plans to lower prescription costs, adding another plan option for beneficiaries. The “One Big Beautiful Bill Act” passed in July placed an expiration date on Medicare coverage for some legal immigrants.
Bers’ job is to keep Medicare advocates, including attorneys, up to date on all these changes so beneficiaries are not blindsided by loss of coverage. The Medicare Advocacy Project can also help people enroll correctly to prevent coverage challenges down the line, or refer them to an unbiased, free counselor.
Buffing up Medicare advocacy
The Medicare Advocacy Project is housed in all the legal aid service offices across the state, but Bers will now offer umbrella services, update educational materials and coordinate these efforts with more training and outreach statewide.
For instance, Bers provides educational materials to local councils on aging, long-term care providers and counselors with the Serving the Health Insurance Needs of Everyone (SHINE) program. This way, Medicare advocates can stay ahead of any pressing issues.
“We’re working with community partners to let them know we’re here and we can be a source of expertise,” Bers said.
Before taking this position, Bers served as the litigation director at a nonprofit legal organization called the Center for Medicare Advocacy. The Longmeadow resident began her legal career as an attorney with Community Legal Aid’s predecessor organization, Western Massachusetts Legal Services. There, she got her first taste of the Medicare system by taking on Medicare advocacy cases as Medicare Part D prescription plans were introduced. Bers calls those early days a “trial by fire.”
“It’s a great opportunity to bring expertise and leadership to a statewide program to enhance and coordinate Medicare advocacy statewide,” Bers said. “We are going to make sure that people in Massachusetts will know they have a place to go, they have a resource to go to when they face a Medicare problem.”
For those who need help during the open enrollment period, call Community Legal Aid at 855-252-5342 and ask for Medicare enrollment assistance. Community Legal Aid has main offices in Greenfield, Northampton, Worcester, Springfield, Pittsfield and Fitchburg, as well as satellite offices in Holyoke and North Adams.