Costs and benefits of various Medicare Plans may differ, but there are some rights that apply to all Medicare beneficiaries:
- Dignity and respect while being treated or acquiring any kind of health care assistance.
- Treatment without discrimination based on race, color, national origin, disability, age, religion, or sex.
- Confidentiality of all personal and health information. (By law, you or your legal representative generally has the right to view and/or get copies of your personal health information).
- Information about Medicare from Medicare, health care providers, and under some circumstances, third parties. This information may include things like what is covered by a particular Medicare Plan; how much Medicare will pay; how much will you pay; how you can file a complaint or appeal; which doctors, specialists and hospitals are included in a particular network; and your treatment options.
- Health care services in your preferred language.
- Emergency Medicare-covered services.
- Claims for coverage
- Notifications on claims and change in Plans.
- Appeals for a disputed coverage decisions.
- Complaints on services provided or their quality.
To protect your rights, Medicare has resources for monitoring and administering beneficiary concerns:
- The Medicare Beneficiary Ombudsman: helps with Medicare-related complaints, grievances, and information requests. The Ombudsman makes sure that information about health care decisions, rights, protections, and resolution of issues is available to you. The Medicare Beneficiary Ombudsman also shares feedback with the Secretary of Health and Human Services, Congress, and other organizations to improve the quality of Medicare services. You can always ask customer support at Medicare to direct your complaints to the Ombudsman’s Office.
- The Competitive Acquisition Ombudsman: helps review and resolve complaints about durable medical equipment (DME) for Medicare beneficiaries, and suppliers in Competitive Bidding Areas. This office responds to individual and supplier inquiries, issues, and complaints. You can be directed to this office through Medicare customer support as well.
- State Health Insurance Assistance Program (SHIP): offers local and personalized counseling to Medicare beneficiaries and their families. This can include information and discussion on queries regarding Medicare benefits, coverage, premiums, deductibles, and coinsurance, as well as resolution of complaints and appeals. SHIP also provides information on joining or leaving Plans, SHIP itself, and the Beneficiary and Family Centered Care Quality Improvement Organization (described next).
- Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO): reviews complaints and quality of care for Medicare beneficiaries to improve effectiveness and efficiency of Medicare services. The BFCC-QIO also provides assistance with filing appeals, complaints, and reviews.
- State Survey Agencies: oversee health care facilities that participate in the Medicare and/or Medicaid programs. These agencies inspect partner facilities and investigate complaints to ensure healthcare standards. These complaints may include issues pertaining to abuse, neglect, mistreatment, poor care, low staffing, unsafe or unsanitary conditions, and dietary problems.
This is not a complete description of Medicare rights and protections. For more information, speak with Medicare customer support at 1-800-MEDICARE, or contact Medigap, Inc. at 1-855-214-4404.