Remember how you learned back in your high school civics class that you have certain rights as an American. As we all know, those individual rights make up the first 10 amendments to our Constitution. But now that you’re older, you may not realize you also have certain rights as a Medicare beneficiary.
Let’s go through the most important ones so that you can protect yourself, if need be. As someone with Medicare, you have the right to:
• Be treated with dignity and respect at all times. That should be so obvious that it doesn’t bear repeating. Even in the most stressful situations, there’s no excuse for anyone in the health care system - from health care professionals to insurers - to treat you with anything other than care and concern.
• Be free from discrimination. Every company that works with Medicare can’t treat you differently because of your race, color, national origin, disability, age or sex. If you think you haven’t been treated fairly for any of those reasons, contact the government’s Office for Civil Rights at hhs.gov/ocr.
• Have your personal and health information kept private. If you’re enrolled in the traditional Medicare program, your privacy rights are spelled out in your “Medicare and You” handbook, which you receive each fall. If you have a private Medicare Advantage plan, your rights are outlined in your health plan’s materials.
• Get clear and simple information about Medicare to help you make health care decisions. You should be told what services and items will be covered, what portion of the bill Medicare will pay and how much you’ll be expected to pay yourself. You should also be told what to do if you want to file a complaint or an appeal.
• Have your questions about Medicare answered. You can visit Medicare’s website at medicare.gov, call the help line at 1-800-633-4227 or contact the Texas Health Information Counseling and Advocacy Program at 1-800-252-9240. If you have a Medicare Advantage plan or a drug plan, you can also call your plan.
• Learn about your treatment options in language you can understand. You have the right to participate fully in all your health care decisions. If you don’t think you’re able to do that, ask a family member, a friend or someone you trust to help you make a decision about what treatment option is best for you.
• Get emergency care when and where you need it. You can get emergency care anywhere in the United States. If you have a Medicare Advantage plan, you don’t need to get permission from your primary care doctor first. But if you’re admitted to the hospital, you or a family member should contact your plan as soon as possible.
• Request a review of certain decisions about your claims or services. You can file an appeal if you disagree with a coverage or payment decision by Medicare or your Medicare Advantage plan. Visit medicare.gov/appeals or call 1-800-633-4227 for details. And remember to keep a copy of everything you send to Medicare or your plan.
• File complaints about the quality of your care. If you don’t speak up, you may not get a resolution to your problem. Complaints about the quality of your care can be directed to the Quality Improvement Organization in Texas. Call 1-844-430-9504. Beneficiaries enrolled in a Medicare Advantage plan can also contact their plan.
Know your rights as a Medicare beneficiary and stand up for them. They’re designed to protect you and ensure you get the care you require.