Rights & Protections for Everyone with Medicare

Medicare beneficiaries have certain guaranteed rights and protections, regardless of the type of plan they choose. These can be found at: https://www.medicare.gov/Pubs/pdf/11534-Medicare-Rights-and-Protections.pdf

Section 1: Rights & Protections for Everyone with Medicare

No matter how you get your Medicare, you have certain rights and protections designed to:

■ Protect you when you get health care.

■ Make sure you get the health care services that the law says you can get.

■ Protect you against unethical practices.

■ Protect your privacy.

You have these rights:

  • Be treated with dignity and respect at all times.

  • Be protected from discrimination.

— Discrimination is against the law. Every company or agency that works 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). See page 2 for more information.

  • Have your personal and health information kept private.

— If you have Original Medicare, see the “Notice of Privacy Practices for Original Medicare.” You can view this notice in the “Medicare & You” handbook. Visit Medicare.gov/publications to view the handbook.

— If you have a Medicare Advantage Plan (like an HMO or PPO), other Medicare health plan, or a Medicare Prescription Drug Plan, read your plan materials.

  • Get information in a way you understand from Medicare, health care providers, and contractors.

  • Get clear and simple information about Medicare to help you make health care decisions, including:

    — What’s covered. — What Medicare pays. — How much you have to pay. — What to do if you want to file a complaint or an appeal.

  • Have your questions about Medicare answered.

    — Visit Medicare.gov. — Call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. — Call your State Health Insurance Assistance Program (SHIP). To get the most up-to-date SHIP phone numbers, visit shiptacenter.org, or call 1-800-MEDICARE.

    — Call your plan if you have a Medicare Advantage Plan, other Medicare health plan, or a Medicare Prescription Drug Plan.

  • Have access to doctors, specialists, and hospitals.

  • Learn about your treatment choices in clear language that you can understand, and participate in treatment decisions.

    You have the right to participate fully in all your health care decisions. If you can’t fully participate, ask a family member, friend, or someone you trust to help you make a decision about what treatment is right for you.

  • Get health care services in a language you understand and in a culturally sensitive way.

    For more information about getting health care services in languages other than English, visit hhs.gov/ocr. You can also get the phone number for your state’s Office for Civil Rights by visiting Medicare.gov/contacts.

  • Get emergency care when and where you need it.

    If your health is in danger because you have a bad injury, sudden illness, or an illness that quickly gets much worse, call 911. You can get emergency care anywhere in the U.S. To learn about emergency care in Original Medicare, visit Medicare.gov, or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

    If you have a Medicare Advantage Plan or other Medicare health plan, your plan materials describe how to get emergency care. You don’t need to get permission from your primary care doctor (the doctor you see first for health problems) before you get emergency care.

    If you’re admitted to the hospital, you, a family member, or your primary care doctor should contact your plan as soon as possible. If you get emergency care, you’ll have to pay your regular share of the cost (co-payment). Then, your plan will pay its share. If your plan doesn’t pay its share for your emergency care, you have the right to appeal.

  • Get a decision about health care payment, coverage of services, or prescription drug coverage.

    When you request coverage for items or services, or a claim is filed for items or services you got, you’ll get a notice from Medicare or be notified by your Medicare Advantage Plan, other Medicare health plan, or Medicare Prescription Drug Plan letting you know what it will and won’t cover. If you disagree with this decision, you have the right to file an appeal.

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

    If you disagree with a decision about your claims or services, you have the right to appeal.

    For more information on appeals:

    — Visit Medicare.gov/appeals.

    — Visit Medicare.gov/publications to view or print the booklet “Medicare Appeals,” or call 1-800-MEDICARE (1-800-633-4227) to find out if a copy can be mailed to you. TTY users can call 1-877-486-2048.

    — If you have a Medicare Advantage Plan, other Medicare health plan, or a Medicare Prescription Drug Plan, read your plan materials.

    — Call the SHIP in your state. To get the most up-to-date SHIP phone numbers, visit shiptacenter.org, or call 1-800-MEDICARE.

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

    — You can file a complaint about services you got, other concerns or problems you have in getting health care, or the quality of the health care you got.

    — If you’re concerned about the quality of the care you received, you have the right to file a complaint.

    — If you have Original Medicare, call your Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO). Visit Medicare.gov/contacts or call 1‑800‑MEDICARE to get your BFCC-QIO’s phone number.

    — If you have a Medicare Advantage Plan (like an HMO or PPO), Medicare drug plan, or other Medicare health plan, call the BFCC-QIO, your plan, or both.

  • If you have End-Stage Renal Disease (ESRD) and have a complaint about your care, call the ESRD Network for your state. ESRD is permanent kidney failure that requires a regular course of dialysis or a kidney transplant. To get this phone number, visit Medicare.gov/contacts, or call 1-800-MEDICARE.

Sol Wynter