By Greg Dill
Know Your Medicare Rights
As a person with Medicare, do you have any rights and protections? You certainly do!
You have rights whether you’re enrolled in Original Medicare – in which you can choose any doctor or hospital that accepts Medicare – or Medicare Advantage, in which you get care within a network of healthcare providers.
Your rights guarantee that you get the health services the law says you can get, protect you against unethical practices and ensure the privacy of your personal and medical information. You have the right to be treated with dignity and respect at all times, and to be protected from discrimination.
You also have the right to get information in a way you understand from Medicare, your health care providers and, under certain circumstances, Medicare contractors. This includes information about what Medicare covers, what it pays, how much you have to pay and how to file a complaint or appeal.
Moreover, you’re entitled to learn about your treatment choices in clear language that you can understand, and to participate in treatment decisions.
One very important right is to get Medicare-covered emergency care when and where you need it – anywhere in the United States. If you have Medicare Advantage, your plan materials describe how to get emergency care. You don’t need permission from your primary care doctor (the doctor you see first for health problems) before you get emergency care.
If you’re admitted to the hospital, you, a family member or your primary care doctor should contact your plan as soon as possible. You’ll have to pay your regular share of the cost, or a co-payment, for emergency care. Then your plan will pay its share.
If your plan doesn’t pay its share, you have the right to appeal. In fact, whenever a claim is filed for your care, you’ll get a notice from Medicare or your Medicare Advantage plan letting you know what will and won’t be covered.
If you disagree with the decision, you have the right to appeal. You don’t need a lawyer to appeal in most cases, and filing an appeal is free. You won’t be penalized in any way for challenging a decision by Medicare or your health or prescription drug plan.
For more information on appeals, you can read our booklet, “Medicare Appeals,” at medicare.gov/Pubs/pdf/11525.pdf. Or call us, toll free, at 1-800-MEDICARE.
If you’re concerned about the quality of the care you received, you have the right to file a complaint. If you have Original Medicare, call your Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO). Visit medicare.gov/contacts or call 1 800 MEDICARE to get your BFCC-QIO’s phone number.
If you have a Medicare Advantage Plan (like an HMO or PPO), Medicare drug plan, or other Medicare health plan, call the BFCC-QIO, your plan or both.
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. To get the phone number for your local ESRD Network, visit medicare.gov/contacts, or call 1-800-MEDICARE.
For more details, read our booklet, “Medicare Rights and Protections,” at medicare.gov/Pubs/pdf/11534-Medicare-Rights-and-Protections.pdf.
At Risk for Hepatitis? Medicare Can Help.
Did you know viral hepatitis, an inflammation of the liver, causes more than one million deaths per year worldwide? That’s about the same number of deaths caused by tuberculosis and HIV combined.
Fortunately, Medicare can help protect you from Hepatitis B and Hepatitis C, the most common types of viral hepatitis in the United States.
Hepatitis is contagious. The Hepatitis B virus, for example, spreads through contact with the blood or other body fluids of an infected person. People can also get infected by coming in contact with a contaminated object, where the virus can live for up to 7 days.
Hepatitis B can range from being a mild illness, lasting a few weeks (acute), to a serious long-term illness (chronic) that can lead to liver disease or liver cancer.
Medicare Part B covers Hepatitis B shots, which usually are given as a series of three shots over a 6-month period. You need all three shots for complete protection. Medicare covers these shots for people at medium or high risk for Hepatitis B.
Risk factors include hemophilia, end-stage renal disease, diabetes, if you live with someone who has Hepatitis B or if you’re a healthcare worker and have frequent contact with blood or body fluids. Check with your doctor to see if you’re at medium or high risk for Hepatitis B. You pay nothing for Hepatitis B shots if your doctor or other qualified healt care provider accepts Medicare payment.
Medicare also covers a one-time Hepatitis C screening test if your primary care doctor or practitioner orders it and you meet one of these conditions:
Medicare also covers anuual repeat screenings for certain people at high risk. Medicare will only cover Hepatitis C screening tests if they’re ordered by a primary care doctor or other primary care provider. You pay nothing for the screening test if the doctor or other qualified healthcare provider accepts Medicare payment.
Hepatitis shots and screening are among the many preventive-health services that Medicare helps pay for. These screenings and tests help detect preventable and chronic diseases early, in their most treatable stages.
Here are some other preventive-health measures Medicare covers:
You pay nothing for most Medicare-covered preventive services if you get the services from a doctor or other qualified healthcare provider who accepts Medicare payment.
However, for some preventive services, you may have to pay a deductible, co-insurance or both. These costs may also apply if you get a preventive service in the same visit as a non-preventive service.
Greg Dill is Medicare’s regional administrator for Arizona, California, Hawaii, Nevada and the Pacific Territories. You can always get answers to your Medicare questions by calling 1-800-MEDICARE (1-800-633-4227).
