Your Rights as a Medicare Enrollee

Medicare Enrollee
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Medicare and the health care providers must give you the information you need, like treatment options, to make informed health care decisions and explain your Medicare rights in a way you can understand.

Whether you have “original” Medicare, a Medicare Advantage Plan, or another type of Medicare health plan, you have rights and protections under federal law. You worked hard and paid a lot of money into the Social Security system from your payroll withholdings for many years. Medicare is not a government handout. You earned the right to receive Medicare benefits. Here are some of your rights as a Medicare enrollee.

The Rights and Protections You Have in Any Kind of Medicare Plan

No matter what type of Medicare plan you have, original Medicare (Medicare Parts A and B), a Medicare Advantage plan (also called Medicare Part C), Medicare Prescription Drug coverage (Medicare Part D), Medicare Advantage Prescription Drug Coverage (MA-D) or another type of Medicare health plan, you have the right to receive dignified, respectful and culturally-sensitive treatment at all times.

  • Every company or agency that contracts with Medicare must follow the laws that prohibit illegal discrimination.
  • The service providers and agencies must protect your privacy and keep your personal and health information private.
  • Medicare and the health care providers must give you the information you need, like treatment options, to make informed health care decisions and explain your Medicare rights in a way you can understand.
  • You should have access to doctors, hospitals, specialists and emergency services.
  • You get to participate in the decisions about your treatment. You can refuse services.

You have the right to appeal coverage and care decisions and to get information in clear language about how to file appeals.

How to Enforce Your Medicare Rights

The federal government provides multiple resources to help people with issues about their rights and protections as Medicare enrollees. For example:

  • If you have a grievance, complaint, or need information, your state Medicare Beneficiary Ombudsman might be able to help. A representative at 1-800-MEDICARE (1-800-633-4277) can connect you with your ombudsman.
  • Your State Health Insurance Assistance Program (SHIP) can provide free counseling and information to help with your Medicare questions.
  • The Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) in your state can help you appeal the termination of Medicare-covered services or hospital discharges you think are too soon.
  • State Survey Agencies inspect health care facilities and agencies like hospitals, nursing homes, hospice and home health agencies. State Survey Agencies investigate concerns about abuse, neglect, poor care, mistreatment and other issues.

With more attention in recent years on the mistreatment of Medicare patients, the federal and governments created these safeguards.

How to Access Your Personal Health Information

You can view or get copies of your personal health information (medical records) from every health care provider that treats you, including doctors, hospitals, laboratories and therapists. You can get your medical information from your health care plan, including Medicare.

You have the right to authorize someone to access your medical records. You can place specific limits on the kind of information the individual, company, or agency can get, and you can designate an expiration date for the authorization, like six months after you sign the form.

Your state might have different regulations than the general law of this article. You should talk to an elder law attorney in your area.

References:

Centers for Medicare & Medicaid. “Eligibility.” (accessed November 7, 2019) https://www.medicare.gov/claims-appeals/your-medicare-rights

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