66+ Rights as a Medicare Beneficiary You Must Know – Take control of your Medicare coverage

If you have Medicare

You have the right to be:

• Treated with courtesy, dignity and respect at all times.
• Protected from discrimination. Every company or agency that works with Medicare must obey the law. They can’t treat you differently because of your race, color, national origin, disability, age, religion, or sex.

You have the right to have:

• Your personal and health information kept private.
• Access to doctors, specialists, and hospitals for 
  medically necessary

   services.

You have the right to get:

• Medicare-covered services in an emergency.
• Information in a way you understand from Medicare, health care providers, and, under certain circumstances, contractors.
• Information about your treatment choices in clear language that you can understand, and participate in treatment decisions.
• Medicare information and health care services in a language you understand.
• Your Medicare information in an accessible format, like braille or large print.
• Answers to your Medicare questions.
• A decision about health care payment, coverage of items and services, or drug coverage.

When you or your provider files a claim, you’ll get a notice letting you know what will and won’t be covered. This notice may come from:

• Medicare
• Your Medicare Advantage Plan (Part C) or other Medicare health plan
• Your Medicare drug plan 

If you disagree with the decision on your claim, you have the right to file an appeal. You can request a review (appeal) of certain decisions about health care payment, coverage of items and services, or drug coverage. If you have concerns about the quality of care and other services you get from a Medicare provider, you can:

• File a complaint (sometimes called a “grievance”).
• Get help from End-Stage Renal Disease (ESRD) Networks and State Survey Agencies to help you with complaints (grievances) about your dialysis or kidney transplant care.

Access to your personal health information

By law, you or your legal representative generally have the right to view and/or get copies of your personal health information from these groups:

• Health care providers who treat you and bill Medicare for your care
• Health plans that pay for your care, including Medicare

These types of personal health information include:

• Claims and billing records
• Information related to your enrollment in health plans, including Medicare
• Medical and case management records
• Other records that doctors or health plans use to make decisions about you

Generally, you can get your information on paper or electronically. If your providers or plans store your information electronically, they generally must give you electronic copies, if you ask for them. You have the right to get your information in a timely manner, but it may take up to 30 days to get a response. Keep in mind, if your information is electronic, you also have the right to have it sent to a third party of your choosing. A third party may be a:

• Health care provider who treats you
• Family member
• Researcher

You may have to fill out a form to request copies of your information and pay a fee. This fee can’t be more than the total cost of:

• Labor for copying the information requested
• Supplies for creating the copy
• Postage (if you ask your health care provider to mail you a copy)

In most cases, you won’t be charged for viewing, searching, downloading, or sending your information through an electronic portal.

More rights based on your situation

When you have Medicare, there are rules that protect your right to fair treatment, access to helpful information, and the privacy of your personal and health records. If you’re a resident of a Skilled Nursing Facility (SNF) or nursing home, or if you’re getting home health or hospice services, you have additional rights under federal and state law. Find out more about your rights and protections.

If you have Original Medicare

You can:

• See any doctor or specialist (including women’s health specialists), or go to any Medicare-certified hospital, that participates in Medicare.
• Get certain information, notices, and appeal rights. These help you resolve issues when Medicare may not (or doesn’t) pay for your health care.
• Request an appeal of health coverage or payment decisions.
• Buy Medicare Supplement Insurance (a Medigap policy).

If you have a Medicare Advantage Plan or other Medicare health plan

You have the same rights and protections as all people with Medicare. You also have the right to:

• Choose health care providers within the plan.
• Get a treatment plan from your doctor.
  • If you have a complex or serious medical condition, a treatment plan lets you directly see a specialist within the plan as many times as you and your doctor think you need.
  • Women have the right to go directly to a women’s health care specialist without a referral within the plan for routine and preventive health care services.
• Know how your doctors are paid.
  • When you ask your plan how it pays its doctors, the plan must tell you.
  • Medicare doesn’t allow a plan to pay doctors in a way that could interfere with you getting the care you need.
• Request an appeal to resolve differences with your plan.
• File a complaint (called a “grievance”) about other concerns or problems with your plan.
• Get a coverage decision or coverage information from your plan before getting services.

To learn more about your rights and protections, read your plan’s membership materials, or call your plan.