Know your Medicare rights
By Greg Dill
As a person with Medicare, do you have any rights and protections? You certainly do!
You have rights whether you’re enrolled in Original Medicare – in which you can choose any doctor or hospital that accepts Medicare – or Medicare Advantage, in which you get care within a network of health care providers.
Your rights guarantee that you get the health services the law says you can get, protect you against unethical practices, and ensure the privacy of your personal and medical information. You have the right to be treated with dignity and respect at all times, and to be protected from discrimination.
You also have the right to get information in a way you understand from Medicare, your health care providers, and, under certain circumstances, Medicare contractors. This includes information about what Medicare covers, what it pays, how much you have to pay, and how to file a complaint or appeal.
Moreover, you’re entitled to learn about your treatment choices in clear language that you can understand, and to participate in treatment decisions.
One very important right is to get Medicare-covered emergency care when and where you need it – anywhere in the United States.
If you have Medicare Advantage, your plan materials describe how to get emergency care. You don’t need 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. You’ll have to pay your regular share of the cost, or a copayment, for emergency care. Then your plan will pay its share.
If your plan doesn’t pay its share, you have the right to appeal.
In fact, whenever a claim is filed for your care, you’ll get a notice from Medicare or your Medicare Advantage plan letting you know what will and won’t be covered.
If you disagree with the decision, you have the right to appeal.
You don’t need a lawyer to appeal in most cases, and filing an appeal is free. You won’t be penalized in any way for challenging a decision by Medicare or your health or prescription drug plan.
For more information on appeals, you can read our booklet “Medicare Appeals,” at https://www.medicare.gov/Pubs/pdf/11525.pdf. Or call us, toll free, at 1-800-MEDICARE.
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 www.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 the phone number for your local ESRD Network, visit Medicare.gov/contacts, or call 1-800-MEDICARE.
For more details, read our booklet, “Medicare Rights and Protections,” at https://www.medicare.gov/Pubs/pdf/11534-Medicare-Rights-and-Protections.pdf?
Greg Dill is Medicare’s regional administrator for Arizona, California, Hawaii, Nevada, and the Pacific Territories. You can always get answers to your Medicare questions by calling 1-800-MEDICARE (1-800-633-4227).