Every person enrolled in Medicare, whether in Original Medicare (Parts A and B), Medicare Advantage (formerly Medicare+Choice), or a Medigap supplemental policy, has certain rights. Some of these rights relate to how enrollees are treated, some relate to enrollees' rights to care, and some relate to information, privacy, and appeals.
How Must Medicare Enrollees Be Treated?
All Medicare enrollees must be treated with dignity and respect, and they may not be subjected to discrimination. Neither Medicare nor any agency or company that works with Medicare may engage in discrimination on the basis of age, race, national origin, color, or disability, and sometimes, religion. Additionally, Medicare enrollees have the right to have information collected by Medicare to be kept private. Medicare employees and contractors asking for personal information must tell enrollees why the information is needed, how it will be used, whether disclosure is mandatory, and the result of nondisclosure.
What Rights To Health Care Does An Enrollee Have?
Enrollees have the right to obtain emergency care anywhere in the U.S. when they feel their health is in serious danger. Enrollees in Medicare Advantage Plans need not get a referral from their primary care physician before obtaining emergency care.
What Rights Do I Have To Information And Privacy?
Medicare enrollees have the right to obtain all the information necessary to make decisions about their treatment, including Medicare cost and coverage information and treatment information. First, an enrollee has a right to obtain information about what Medicare will cover and pay and how much he or she, as a patient, will have to pay. The right is paired with a corresponding right to have Medicare questions answered. Second, an enrollee has the right to fully participate in his or her treatment decisions. This includes the right to be informed of available treatment choices in understandable terms.
Enrollees also have the right to speak with their health care providers in private and to have their personal information kept private. Providers must give patients a notice that explains patient privacy rights, as well.
What Rights Do I Have To Complain Or Appeal?
There are three avenues enrollees can use to address concerns or complaints, depending on the nature of the concern. First, enrollees have the right to appeal decisions refusing payment for medical services, denying coverage, or terminating coverage. Second, enrollees have the right to file complaints or grievances if they feel that the quality of services they are receiving is not up to par. Third, enrollees have the right to file complaints for privacy violations.
What Other Rights Do I Have As A Medicare Enrollee?
Medicare enrollees have additional rights depending upon the type of plan in which they are enrolled. For instance, enrollees in Medicare's Original Plan have rights to hospital, home health, and skilled nursing care; to buy a Medigap supplemental policy; and to choose their providers within Medicare-participating providers. All enrollees have rights to culturally competent services and to appeal procedures, as well.
Copyright 2012 LexisNexis, a division of Reed Elsevier Inc.