Your Medicare Rights

Medicare comes with important rights, no matter which plan you choose. Compared to most private health insurance, Medicare has some of the best consumer protections.

The Medicare plans include:  

• The Original Medicare Plan 
• Medicare Advantage Plans, Including: 

  o Medicare Health Maintenance Organizations (HMO)  

  o Medicare Preferred Provider Organizations (PPO)

  o Medicare Private Fee-for-Service (PFFS) Plans

• The Medicare Prescription-Drug Plan

In Medicare, you have the right to:

• Be respected 
• Be protected against discrimination 
• Get information and assistance 
• Get health care from doctors and hospitals
•  Know and participate in treatment choices 
• Resolve complaints
• Have your personal information kept private 

You can find more details about these and other rights in Your Medicare Rights and Protections (Adobe Acrobat Required) on the Medicare Web site (www.Medicare.Gov).

Be Respected
You have the right to be treated with dignity and respect at all times.

Be Protected Against Discrimination
You have the right to be treated fairly and to receive good care no matter what your race, color, national origin, sex, disability, age, or religion. If you feel that you have been treated unfairly, call the nearest U.S. Department of Health and Human Services Office for Civil Rights. You can also find the number in your area by calling, toll-free, 800-368-1019 (voice) or 800-537-7697 (TDD).

Get Information and Assistance
You have the right to get the information you need to make good health care decisions. This information includes:

• What benefits are covered
• What Medicare will pay
• What you will pay
• How to file a complaint

You also have the right to get your questions answered. Get information and help you can trust from the Medicare Web site and through the toll-free Medicare helpline, 800-Medicare (633-4227). You can also call your State Health Insurance Assistance Program. SHIPs offer free health-insurance counseling.

Get Health Care From Doctors and Hospitals
You have the right to get health care from doctors and hospitals. In the Original Medicare Plan, you can go to any doctor or hospital in the country that accepts Medicare. Most do. In a Medicare Private-Fee-for-Service plan, you can go to any doctor or hospital who agrees to the plan’s terms. In either Original Medicare or in a Medicare PFFS, you can switch doctors for any reason.

In a Medicare HMO, you receive most health care from doctors who are part of the plan's network. You choose a primary care doctor from the plan's network. Your primary care doctor manages your care, sends you to specialists, and admits you to the hospital, if needed. However, if you have a complex or serious medical condition, you can get a treatment plan from your primary doctor that allows you to go directly to a specialist.

In a Medicare PPO, you can go to doctors or hospitals outside the plan's network, but you pay more to do so. However, both Medicare HMOs and PPOs must pay for you to see a doctor outside the plan's network if no doctor in the network can give you the service you need. You have the right to get emergency care when and where you need it, no matter which Medicare plan you have. An emergency is defined as a time when you think your health is in serious danger from an injury, sudden illness, or an illness that is getting worse.

If you are in a Medicare Advantage plan, such as a Medicare HMO or PPO, you do not need permission before getting emergency care.

Know and Participate in Treatment Choices
You have the right to talk to your doctor about your health care and all your treatment choices. You have a right to hear this information in a way that you can understand. If you don't speak or understand English, you have a right to an interpreter who can help you talk to your doctor. You also have the right to get health care that is sensitive to your culture.

You have the right to be a part of any decision about your health care. You can ask someone else, such as a friend or relative, to help you with your decision.

Know How to File A Complaint
You have the right to file a complaint with your Medicare plan. There are two kinds of complaints; appeals and grievances.

• Appeals

There are times when your Medicare plan may refuse to provide a service or reduce or may end care you think you need. You always have the right to ask the plan to review its decision by filing an appeal. If you think you need the care, don't take "no" for a final answer. Many appeals are successful.

• Grievances

No matter which Medicare plan you are in, you have the right to file a grievance if you think you are not getting quality health care. If you want to complain about the quality of your care, contact the Quality Improvement Organization in your state. Quality Improvement Organizations are groups of practicing doctors paid by Medicare to check and improve the care given to people with Medicare.

If you are in a Medicare HMO or PPO, you can also file a grievance if you have complaints about the way care is given. For example, you can file a grievance if you have problems:
                o    Reaching your doctor or the plan by phone
                o    Coping with staff behavior
                o    Getting an appointment to see your doctor
                o    Getting a referral to a specialist
                o    Receiving a medical service

Have Your Personal Information Kept Private
You have the right to have your personal information, such as your address and telephone number, kept private. You also have the right to have your personal health information, such as your medical diagnoses, kept confidential and to talk to your doctor in private. Recent improvements to privacy rules give you more access to your medical records and more control over how your health information is used. If you are asked for personal information, you have a right to know:

• Why it is needed and how it will be used
• What happens if you do not provide the requested information

Your state may have additional privacy laws that protect your personal information. Check with your State Health Insurance Assistance Program to learn more about the laws in your state.