Know Your Medicare Rights

As a Medicare beneficiary, you are entitled to certain rights and protections under the law. These rights are designed to protect your privacy, protect you against unethical practices, and ensure you get the health care you need.

In this guide, we explore your rights as they relate to the different parts of Medicare. We encourage you to print a copy of the guide and refer to it as you explore your Medicare options.

Couple researching in a library

Your rights under Original Medicare

If you’re enrolled in Original Medicare (Medicare Part A and Part B), you have the right to:

  • See any doctor or specialist that participates in Medicare
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  • Go to any Medicare-certified hospital
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  • Obtain information about notices of noncoverage
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  • Request an appeal of payment decisions and/or health coverage
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  • Purchase Medicare Supplement Insurance during your Medigap Open Enrollment Period*

Your rights under Medicare Advantage

If you are enrolled in a Medicare Advantage (Medicare Part C) plan, you have the right to:

  • Choose any health care providers within your plan network
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  • Get coverage information from your plan before getting services
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  • Know how your doctors are paid
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  • File grievances about plan problems or concerns
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  • Request an appeal to resolve plan differences
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  • Get a treatment plan from your doctor for serious medical conditions. (Treatment plans allow you to see a specialist as many times as you and your doctor think is appropriate).

Note: you must be enrolled in Original Medicare to qualify for Medicare Advantage.

Your rights under Medicare Prescription Drug Plans

If you have a Medicare Prescription Drug Plan (Medicare Part D), you have the right to:

  • Request a coverage determination to resolve differences with your drug plan
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  • File a complaint with the plan
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  • Have the privacy of your health and drug information protected

Universal Rights

There are also rights that every Medicare beneficiary is entitled to, including protection from discrimination, the right to privacy, the right to Medicare information (in a language you understand), and the right to file a complaint or appeal. 

For more information about your Medicare options or your rights under Medicare, speak with a licensed insurance agent at   TTY Users: 711.

 

Source: Centers for Medicare and Medicaid Services “Medicare Rights and Protections” published January 2018. https://www.medicare.gov/Pubs/pdf/11534-Medicare-Rights-and-Protections.pdf 

* Medigap policies may not be available to individuals younger than 65. The following states require that insurance companies offer at least one type of Medicare Supplement Insurance plan to people under 65 who receive Medicare benefits: California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Illinois, Kansas, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Texas, Vermont and Wisconsin. Note: California, Massachusetts and Vermont require that insurance companies offer at least one Medigap policy to people under 65 who are disabled. This requirement does not include those who are under 65 and have end-stage renal disease. Delaware requires that insurance carriers offer at least one Medigap policy to those under 65 who have ESRD. This requirement does not include those under 65 who are disabled.

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MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.