Your Medicare Rights: Empower Yourself

No matter how you get Medicare, you have certain rights and protections! These are designed to protect you when you receive healthcare, protect your privacy, protect you against unethical practices and to make sure you get the healthcare services you are eligible for.

These rights are yours through Medicare, and it’s important that you know how these can help your ability to receive care, even when you have encountered a problem or concern.

Let’s go over the list of rights that are outlined by the Centers for Medicare Services (CMS), starting with rights that apply to everyone in Medicare — no matter what kind of plan you have.

Rights and Protections for Everyone With Medicare

Medicare includes a list of rights that are yours with all types of Medicare, including Original Medicare, Medicare Advantage and Medicare prescription drug plans.

You can read these in full detail in the online Medicare Rights & Protections brochure.

Your rights under Medicare:

Be treated with dignity and respect at all times.

Be protected from discrimination.

Discrimination is against the law, and companies or agencies that work with Medicare must obey the law and can’t treat you differently because of your race, color, national origin, disability, age or sex (or gender identity).

Have your personal and health information kept private.

For details, those with Original Medicare can view the “Notice of Privacy Practices for Original Medicare,” and those with other plans should also read their plan materials.

Get information in a way you understand from providers.

Get clear and simple information about Medicare to help you make healthcare decisions.

This includes what’s covered, what Medicare pays, how much you need to pay and how to file a complaint or appeal.

Get your Medicare questions answered.

You can visit Medicare.gov or call 1-800-MEDICARE (TTY users call 1-877-486-2048). You can also contact your State Health Insurance Assistance Program, or your plan if you have additional coverage beyond Original Medicare.

Have access to doctors, specialists and hospitals.

Learn about your treatment choices in clear language, and participate in treatment decisions.

It’s your right to participate in your healthcare decisions. If you cannot, ask a family member or trusted other to help you make a decision about treatment plans.

Get healthcare services in a language you understand and in a culturally sensitive way.

Get emergency care when and where you need it.

You can get emergency care anywhere in the U.S. if your health is in danger because of a bad injury, sudden illness or an illness that quickly gets worse.

Emergency care coverage is different in Original Medicare, Medicare Advantage or other Medicare health plans, so consult your plan materials to know how to get emergency care. Your plan information will also have information about costs and how to appeal if needed.

Get a decision about healthcare payment, coverage of services or prescription drug coverage.

When you request services or a claim is filed, you’ll get a notice from Medicare or your plan letting you know what it will and won’t cover. You have the right to file an appeal if you disagree with the decision.

Request a review (appeal) of certain decisions about healthcare payment, coverage of services or prescription drug coverage.

1. Medicare.gov/appeals
2. Medicare.gov/publications to view the booklet “Medicare Appeals”
3. For Medicare Advantage plans, other Medicare health plans or a Medicare prescription drug plan, consult your plan materials
4. Call the State Health Insurance Assistance Program in your state

File complaints (sometimes called “grievances”), including complaints about the quality of your care.

You can file a complaint about services you received, problems getting healthcare or the quality of healthcare received. For Original Medicare, call your Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO). For contact information, visit Medicare.gov/contacts. For other Medicare plans, contact your plan, the BFCC-QIO or both.

Additional Rights in Original Medicare

With Original Medicare, you have additional rights beyond the list we have already gone over above. These include:

• You can see any doctor or specialist (including women’s health specialists), or go to any Medicare-certified hospital, that participates in Medicare.
• You can get certain information, notices and appeal rights that help you resolve issues when Medicare may not or does not pay for healthcare.
• You may request an appeal of healthcare coverage or payment decisions.
• You can buy a Medicare Supplement Insurance (Medigap) policy.
  • There are certain times when an insurance company must sell you a Medigap policy, even if you have preexisting health problems.

Your Rights in a Medicare Advantage Plan, Other Medicare Health Plan or Medicare Prescription Drug Plan

When you have coverage other than Original Medicare, there are other rights to consider, which may be different from your rights under Original Medicare. For example, your list of covered providers may be different, and the process for understanding claims and filing appeals may also differ from Original Medicare.

If you want to know more about your rights, read your plan’s membership materials or call your plan.

Your Protections Under Original Medicare

What is an Advance Beneficiary Notice of Noncoverage?

Under Original Medicare, you’ll be notified if your doctor, other healthcare provider or supplier thinks Medicare won’t pay for the items or services you’ll get. This notice is called an “Advance Beneficiary Notice of Non-Coverage,” or ABN. The ABN lists the items or services that your doctor or healthcare provider expects Medicare will not pay for, along with an estimate of what you might need to pay.

Once you receive an ABN, you have options, which we will cover here briefly. For full details on ABNs and how they can affect your treatment decisions, please view this official Medicare page: https://www.medicare.gov/basics/your-medicare-rights/your-protections

Option 1: Choosing the non-covered services while filing a claim to Medicare for payment. In this case, you may still need to pay for the services, even while waiting for reimbursement.

Option 2: Choosing the non-covered services and paying for them out of pocket.

Option 3: Not choosing to receive the non-covered services.

To learn more about the kinds of ABNs and more about your options, consult the Medicare.gov “Your Protections” page: https://www.medicare.gov/basics/your-medicare-rights/your-protections

Conclusion

Medicare offers a long list of rights and protections that are designed to help you receive care that is appropriate and respectful, no matter who you are or how you receive your Medicare. The whole topic of Medicare rights can feel overwhelming, but we hope we’ve given you some understanding and further resources to learn more.

If you have any questions about Medicare or Medicare coverage, please feel free to give us a call. One of our PlanEnroll agents will be happy to help you. Call us today to speak with a licensed insurance agent.

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