Section 2: Your Medicare Rights
If you have Medicare, you have certain guaranteed rights and protections.
You have these rights whether you have the Original Medicare Plan (with or
without a Medigap policy) or a Medicare Health Plan. You have the right to
the following:
1. Be treated with dignity and respect at all times
2. Be protected from discrimination
Discrimination is against the law. Every company or agency that
works with Medicare must obey the law. You can’t be treated
differently because of your
• race,
• color,
• national origin,
• disability,
• age,
• religion, or
• sex (under certain conditions).
Also, your rights to health information privacy are protected. If
you think that you haven’t been treated fairly for any of these
reasons, call the Office for Civil Rights in your state. Call toll-free
1-800-368-1019. TTY users should call 1-800-537-7697. You can
also visit www.hhs.gov/ocr on the web for more information.
3. Get information about Medicare that you can
understand to help you make health care decisions
This information includes
• what is covered,
• what costs are paid,
• how much you have to pay, and
• what to do if you want to file a complaint.
You can have someone help you make decisions when you need it.
4. Have your questions about the Medicare
Program answered
You can call 1-800-MEDICARE (1-800-633-4227) to get your
questions answered or get the telephone number of your State
Health Insurance Assistance Program. TTY users should call
1-877-486-2048. If you enrolled in a Medicare Health Plan, you
can also call your plan.
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Section 2: Your Medicare Rights
5. Culturally competent services
You have the right to get health care services in a language you can
understand and in a culturally sensitive way. For more information
about getting health care services in languages other than English,
call the Office for Civil Rights in your state or call toll-free
1-800-368-1019. TTY users should call 1-800-537-7697. You can
also visit www.hhs.gov/ocr on the web for more information.
6. Get emergency care when and where you need it
A medical emergency is when you think your health is in serious
danger—when every second counts. If you think your health is in
danger because you have a bad injury, sudden illness, or an illness
quickly getting much worse, you can get emergency care anywhere
in the United States.
If you are enrolled in a Medicare Health Plan, your plan materials
describe your emergency care costs. You don’t need to get
permission from your primary care doctor before you get
emergency care. Your primary care doctor is the doctor you see
first for health problems. If you are admitted to the hospital, you,
a family member, or your primary care doctor should contact your
Medicare Health Plan as soon as possible so the plan can manage
your care.
If you get emergency care, you will have to pay your regular share
of the cost (copayment). Then, your plan will pay its share. If your
plan doesn’t pay its share for your emergency care, you have the
right to appeal (see page 9).
7. Learn about all of your treatment choices in clear
language that you can understand
You have the right to fully participate in all your health care
decisions. If you can’t fully participate, you can ask family
members, friends, or anyone you trust to help you make a decision
about what treatment is right for you. Medicare Health Plans can’t
have rules that stop your doctor from telling you what you need to
know about your treatment choices.
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Section 2: Your Medicare Rights
8. File a complaint
You can file a complaint about payment, services you received, other
concerns or problems you have in getting health care, and the quality of
the health care you received.
Your Medicare Quality of Care Concerns
You have a right to file a complaint if you think you aren’t getting
quality services or you have quality of care issues. This type of
complaint is called a “grievance” if you are enrolled in a Medicare
Health Plan or a Medicare drug plan. If you are enrolled in the
Original Medicare Plan or a Medicare Health Plan and if you want
to file a complaint about the quality of health care you have
received, you can call your plan or call the Quality Improvement
Organization in your state. To get this telephone number, call
1-800-MEDICARE (1-800-633-4227). TTY users should call
1-877-486-2048.
9. Your Medicare Appeal Rights
You have the right to appeal decisions relating to your claims for
benefits. For more information on appeals, see Sections 3–5 in this
booklet or call the State Health Insurance Assistance Program in your
state. To get this telephone number call 1-800-MEDICARE
(1-800-633-4227). TTY users should call 1-877-486-2048.
Important: If you need help with filing an appeal, you can have
someone else help you. This process is called an “Appointment of
Representative.” You can name a family member, friend, advocate,
attorney, doctor, or someone else to act on your behalf. Medicare has a
form you and your representative can fill out to complete this process.
This form is available at www.medicare.gov/basics/forms/default.asp on
the web (CMS Form Number 1696). You can also appoint a
representative with a letter signed and dated by you and the person
helping you. The form or letter must be sent with your appeal request.
If you have questions about appointing a representative, you can call
1-800-MEDICARE (1-800-633-4227). TTY users should call
1-877-486-2048.
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