A Full Spread of Medicare Rights and Protections

Medicare serves up a buffet of rights for all enrollees. And includes added rights under certain plans—protecting you from bias, immoral or unlawful treatment. Hopefully, you’ll never need to use these rights. But you need to know and understand them.

Your Rights, Briefly

You have the right to:

• Dignity: You're treated with courtesy and respect at all times and protected from discrimination.
• Privacy: Your personal and health information kept private.
• Understanding: You get clear and simple information in a language you understand and in an accessible format from Medicare, health care providers, and contractors. This includes treatment choices and your participation in treatment decisions, answers to your Medicare questions, what’s covered, your cost, and how to file a complaint or appeal.
• Understanding: You have access to doctors, specialists, and hospitals for medically necessary services And includes Medicare-covered services in an emergency.
• Understanding: You have the right with requesting an appeal if you don’t agree with health care payments, coverage of items and services, or drug coverage from Medicare, your Medicare Advantage plan, your drug plan, or other Medicare health plan.
• Understanding: You can file a complaint or grievance about the quality of your care and other services received from a Medicare provider.

You have other rights depending on your plan:

• If you have Original Medicare, you have the right to buy Medicare Supplement Insurance, also known as Medigap.
• If you have Medicare Advantage, you have the right to get a treatment plan from your doctor. And you can see a specialist as often as needed. In many cases, you can only use providers in the plan’s network and service area for non-emergency care. You may also need to get a referral to use a specialist. You also have the right with knowing how to get coverage information before getting services.

Keep These Helpful Numbers

If you feel your rights have been abused, it’s important you reach out. Here are important contacts you need to know.

If you have a question about Medicare:

• Visit Medicare.gov
• Call 1‐800‐MEDICARE (1‐800‐633‐4227) (TTY: 1‐877‐486‐2048).
• Call your State Health Insurance Assistance Program (SHIP). For 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.

If you have a complaint:

• For Original Medicare, call your state’s Beneficiary and Family Centered Care Quality Improvement Organization (BFCC‐QIO). Visit Medicare.gov/contacts Or call 1‐800‐MEDICARE (1‐800‐633‐4227) (TTY: 1‐877‐486‐2048)to get your BFCC‐QIO’s phone number.
• For a Medicare Advantage Plan, Medicare drug plan, or other Medicare health plan, call the BFCC‐QIO, your plan, or both.
• If you have End-Stage Renal Disease (ESRD), work with your ESRD Networks and State Survey Agencies. To get this phone number, visit Medicare.gov/contacts Or call 1‐800‐MEDICARE.
• If you feel you’ve been discriminated against, call the Department of Health and Human Services, Office for Civil Rights, 1‐800‐368‐1019 (TTY: 1‐800‐537‐7697). Or visit hhs.gov/ocr/civilrights/complaints

If you want to appeal a coverage decision:

• Visit Medicare.gov/appeals
• Visit Medicare.gov/publications to view or print the “Medicare Appeals” booklet. Call 1‐800‐MEDICARE (1‐800‐633‐4227; TTY: 1-877-486-2048) for a mailed copy.
• If you have a Medicare Advantage Plan, other Medicare health plan, or a Medicare Prescription Drug Plan, read your plan materials.
• Call your State Health Insurance Assistance Program (SHIP). For the most up‐to‐date SHIP phone numbers, visit ShiptaCenter.org Or call 1‐800‐MEDICARE.

A Medicare Beneficiary Ombudsman helps with questions and complaints and makes sure Medicare information is available. You can also provide feedback to the Ombudsman to help improve your experiences with Medicare. Visit Medicare.gov to learn more. Or call 1‐800‐MEDICARE (1‐800‐633‐4227) (TTY: 1‐877‐486‐2048).

At Your Service

No matter how you get Medicare, you have rights and protections that: 1) provide for your safety when you get health care; 2) ensure you get the health care services the law says you can get; and 3) shield you against unethical practices.

And you’re not alone at the table. Our licensed agents are at your service. They’ll answer your Medicare questions and guide you through your entire spread of Medicare rights and protections.

MR511a 1/2024