Everyone with Medicare has rights and protections regardless of how they get their Medicare. Meanwhile, Original Medicare, Medicare Advantage, and Medicare Part D have their own rights and protections. Medicare rights and protections include rights to privacy, rights to appeal, rights to clear information, and protections from discrimination.[1]

Everyone with Medicare has the right to:

  • Be treated with dignity and respect at all times.
  • Be protected from discrimination, meaning that no company or agency that works with Medicare can treat you differently based on race, color, national origin, disability, age, religion, or sex.
  • Have personal and health information kept private.
  • Get information in a format and language you understand from Medicare, health care providers, Medicare plans, and Medicare contractors.
  • Get answers to your Medicare questions and to get understandable information. This means getting information in a way you understand from Medicare, health care providers, and, under certain circumstances, contractors. And, this means, Getting understandable information about Medicare to help you make health care decisions, including what’s covered, what Medicare pays, how much you have to pay, and what to do if you want to file a complaint or appeal.
  • Have access to doctors, other health care providers, specialists, and hospitals for medically necessary services.
  • Learn about your treatment choices in clear language you can understand, and participate in treatment decisions.
  • Get healthcare services in a language you understand and in a culturally-sensitive way.
  • Get Medicare-covered services in an emergency.
  • Get a decision about health care payment, coverage of services, or drug coverage and when a claim is filed, get a notice letting you know what won’t be covered.
  • Request a review (appeal) of certain decisions about health care payment, coverage of services, or drug coverage.
  • File complaints (sometimes called “grievances”), including complaints about the quality of your care.

There are additional rights and protections based on what type of Medicare you have as well.

With Original Medicare, you also have the right to:

  • 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 health care. Learn about notices of noncoverage.
  • Request an appeal of health coverage or payment decisions.
  • Buy a Medicare Supplement Insurance (Medigap policy ).

With Medicare Advantage, 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.

With Medicare Drug plans, you also have the right to:

  • Get a written explanation for drug coverage decisions (called a “coverage determination”) from your Medicare drug plan.
  • File a complaint (called a “grievance”) with the plan.
  • Have the privacy of your health and prescription drug information protected.
Citations

  1. Rights & protections for everyone with Medicare. Medicare.Gov.