Medicare Rights, Las Vegas, Nevada, Finding

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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Published In: Administrative Agency Updates, Civil Remedies Updates, Consumer Protection Updates, Health Updates, Personal Injury Updates

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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