You have the right to:
- Be treated with courtesy, dignity, and respect at all times.
- Be 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. - Have your personal and health information kept private.
- If you have Original Medicare, you can read our detailed privacy practices
in your “Medicare & You” handbook or at Medicare.gov/basics/reportingmedicare-fraud-and-abuse/privacy-practices-original-medicare. - If you have a Medicare Advantage Plan, other Medicare health plan, or a
Medicare drug plan, read your plan materials.
2 Section 1: Your Medicare Rights & Protections - Get easy to understand information about Medicare, like:
- What’s covered.
- What Medicare pays for covered items and services.
- How much you’ll have to pay.
- How to file a complaint or an appeal.
- Get answers to your Medicare questions.
- Visit Medicare.gov.
- Call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
- Call your State Health Insurance Assistance Program (SHIP) for free personalized
health insurance counseling. Visit shiphelp.org to get your local SHIP’s contact
information. - Call your plan if you have a Medicare Advantage Plan, other Medicare health plan,
or a Medicare drug plan. - Have access to providers, specialists, and hospitals for medically necessary services.
- Participate fully in all your health care decisions. If you can’t participate fully, ask a
family member, friend, or someone you trust to help you make a decision about what
treatment is right for you. - Get Medicare information and health care services in a language you understand.
For more information, visit HHS.gov/ocr or contact your state’s Office for Civil Rights. - Get your Medicare information in an accessible format, like braille or large print.
Go to “Accessible Communications” on page 11 for more information. - Get emergency care when and where you need it.
- If your health is in danger because you have a severe injury, sudden illness, or
an illness that quickly gets much worse, call 911. You can get emergency care
anywhere in the U.S. - To learn more about getting care and drugs in a disaster or emergency, visit
Medicare.gov/publications/11377-getting-care-and-drugs-in-a-disaster-oremergency.pdf. - Get decisions about coverage and payment. When you or your provider files a claim
or request for drug coverage, 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,
other Medicare health plan, or your Medicare drug plan. If you disagree with the
plan’s decision, you have the right to file an appeal. - Ask for an appeal of certain decisions about health care payment, coverage of items
and services, or drug coverage. For more information on appeals: - Visit Medicare.gov/appeals.
- Visit Medicare.gov/publications to read or print the booklet “Medicare Appeals,”
or call 1-800-MEDICARE (1-800-633-4227) to find out if a copy can be mailed to
you. TTY users can call 1-877-486-2048.
Section 1: Your Medicare Rights & Protections 3 - If you have a Medicare Advantage Plan, other Medicare health plan, or a
Medicare drug plan, read your plan materials. - Call the State Health Insurance Assistance Program (SHIP) in your state. Visit
shiphelp.org to get your local SHIP’s contact information. - File complaints (also called “grievances”), including complaints about the quality of
care and other services you get from a Medicare provider. - If you have Original Medicare, call your Beneficiary and Family Centered
Care Quality Improvement Organization (BFCC-QIO). Your local BFCC-QIO is
administered for Medicare by www.livantaqio.cms.gov/en or acentraqio.com/,
depending on what state you live in. Check their websites to make sure you’re
contacting the right organization for your state. - If you have a Medicare Advantage Plan, other Medicare health plan, or Medicare
drug plan, call the BFCC-QIO, your plan, or both. - Visit Medicare.gov/providers-services/claims-appeals-complaints/complaints
to learn more about filing a complaint.
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. You can visit esrdnetworks.org/
membership/esrd-networks-contact-information/ to find contact information for
your local ESRD network.
Your rights in Original Medicare
If you have Original Medicare, you have the right to: - Use any health care provider or specialist (including women’s health specialists) or
any Medicare-certified hospital that participates in Medicare. - Get certain information and notices that help you understand the medical services
you get and resolve issues when Medicare may not (or doesn’t) pay for health care. - Ask for an appeal of health care coverage or payment decisions.
- Buy a Medicare Supplement Insurance (Medigap) policy. There are certain times,
including during your Medigap Open Enrollment Period, when an insurance
company must sell you a Medigap policy, even if you have pre-existing health
conditions. Visit Medicare.gov/health-drug-plans/medigap/basics for more
information about Medigap.
4 Section 1: Your Medicare Rights & Protections
Your rights in a Medicare Advantage Plan or other Medicare
health plan
If you have a Medicare Advantage Plan or other Medicare health plan, you have the same
rights and protections as everyone with Medicare. You also have the right to: - Choose your health care providers from within the plan’s network. For example,
women have the right to go directly to a women’s health care specialist within their
plan without a referral for routine and preventive health care services. - Get a treatment plan from your doctor. If you have a complex or serious medical
condition, a treatment plan lets you use a specialist within the plan as many times as
you and your provider think you need, without a referral. - Know how your plan pays your providers. When you ask your plan how it pays
providers, the plan must tell you. Medicare doesn’t allow a plan to pay providers in a
way that could interfere with you getting the care you need. - Get a coverage decision or coverage information from your plan before getting
services. - Ask your plan to pay for an item or service you think should be covered. You can call
your plan before you get an item, service, or prescription to check if it’s covered. - Ask for an appeal to resolve differences with your plan. You have the right to appeal
if your plan denies your request or denies payment for an item, service, or drug. - File a complaint (also called a “grievance”) about other concerns or problems with
your plan. Check your plan’s membership materials or call your plan to find out how to
file a complaint.
Your rights if you have Medicare drug coverage
If you have a Medicare drug plan or Medicare Advantage Plan with drug coverage, you
have the same rights and protections as everyone with Medicare. If you have Medicare drug
coverage, your plan will send you information that explains your rights. You have the right to: - Ask for a coverage determination or appeal to resolve differences with your plan. If
your pharmacist, doctor, or other prescriber tells you that your plan won’t cover a drug
you think should be covered, or it will cover the drug at a higher cost than you think
you’re required to pay, you can request a coverage determination from your plan.
If your plan denies your request, you have the right to appeal that decision. For more
information on the appeals process, visit Medicare.gov/appeals. - File a complaint (called a “grievance”) with the plan. For more information on filing
a complaint, visit Medicare.gov/providers-services/claims-appeals-complaints/
complaints.