What to Know About Medicare and Your Personal Health Information

In this day and age, the privacy of your personal information is more important than ever. And because older adults are popular targets for scammers, many Medicare beneficiaries may be wondering if Medicare is sharing or somehow compromising their private health information. 

Medicare is required by law to protect the privacy of your personal health and medical information. Below is a look at some of the instances in which Medicare may use or disclose your information and how. 

Doctor reviews information with patient

There are certain people who have a right to obtain your information

Medicare is required to share your information with the following parties, when requested:

  • Yourself
  • Someone who was designated by you or who has acquired the legal right to act on your behalf
  • The Secretary of the Department of Health and Human Services (HHS), if and when necessary
  • Anyone for whom the law requires

Medicare has the right to use and provide your information to operate and pay for your care

Your information may be used for the following actions:

  • Pay or deny claims
  • Collect premiums
  • Share your benefit payments with other insurers you may have
  • Prepare your Medicare Summary Notice
  • Provide you with customer service
  • Resolve complaints
  • Contact you about research studies
  • Ensure you receive quality care

There are certain circumstances in which Medicare may use or share your information

Medicare is allowed to share your personal information under the following circumstances:

  • Public health activities such as reporting disease outbreaks 
  • Government oversight actions such as investigating fraud or abuse
  • Judicial and administrative proceedings such as responding to a court order
  • Law enforcement purposes such as information needed to find a missing person
  • Research studies that meet privacy law requirements
  • Avoiding a serious or imminent threat to health or safety
  • Contacting you about your benefits
  • As requested by health care providers for care coordination

You have rights as a Medicare beneficiary

As a Medicare beneficiary, you are protected by certain rights concerning your private information.

Your Medicare rights include:

  • Obtaining a copy of the information that Medicare has about you
  • Obtaining a list of people who have received information about you
  • Requesting that Medicare communicates with you in a different manner, such as by sending materials to a P.O. Box instead of your home address
  • Requesting Medicare to limit how your information is used and shared for paying claims 
  • Obtaining a letter that details the risk of your privacy

For more information about Medicare’s use of your private information, you may call 1-800-MEDICARE and speak to a customer service representative.

You may have additional Medicare coverage options

Depending on where you live, there may be Medicare Advantage (Medicare Part C) and Medicare Part D prescription drug plans available in your area.

Medicare Advantage plans replace your Original Medicare coverage (Part A and Part B), and many plans include coverage for prescription drugs, which Original Medicare doesn’t typically cover.

To learn more about the plan options available near you, call to speak with a licensed insurance agent today. You can also compare plans online for free, with no obligation to enroll.​

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