MEDICARE MINUTE

What are My Medicare Rights?

All people with Medicare have certain rights and protections. You have the right to:

• Be treated with courtesy, dignity, and respect at all times.

• Be protected from discrimination.

• Have personal and health information kept private.

• Get information in a way you understand from Medicare, health care providers, and, under certain circumstances, contractors.

• Learn about your treatment choices in clear language you can understand, and participate in treatment decisions.

• Get Medicare information and health care services in a language you understand.

• Get your Medicare information in an accessible format, like braille or large print. Note: If you need plan information in a language other than English or in an accessible format, contact your plan.

• Get answers to your Medicare questions.

• Have access to doctors, specialists, and hospitals for medically necessary services.

• Get Medicare-covered services in an emergency.

• Get a decision about health care payment, coverage of items and services, or drug coverage. When you or your provider files a claim, you’ll get a notice letting you know what will and won’t be covered. This notice comes from one of these:

• Medicare

• Your Medicare Advantage Plan (Part C) or other Medicare health plan

• Your Medicare drug plan for Medicare drug coverage (Part D)

If you disagree with the decision of your claim, you have the right to file an appeal.

• Request a review (appeal) of certain decisions about health care payment,coverage of items and services, or drug coverage.

• Be able to file complaints (sometimes called “grievances”), including complaints about the quality of your care. You can file a complaint if you have concerns about the quality of care and other services you get from a Medicare provider.

What are my rights if my plan stops participating in Medicare?

Medicare health and drug plans can decide not to participate in Medicare for the coming year. In these cases, your coverage under the plan will end after December 31. Your plan will send you a letter explaining your options. If this happens:

• You can choose another plan between October 15 –December

7. Your coverage will begin January 1.

• You’ll also have a special right to join another Medicare plan until February 28, 2022.

• You may have the right to buy certain Medigap policies within 63 days after your plan coverage ends.

Your Right to Access Your Personal Health Information

By law, you or your legal representative generally has the right to view and/or get copies of your personal health information from health care providers who treat you, or by health plans that pay for your care, including Medicare. In most cases, you also have the right to have a provider or plan send copies of your information to a third party that you choose, like other providers who treat you, a family member, a researcher, or a mobile app you use to manage your personal health information.

This includes:

• Claims and billing records

• Information related to your enrollment in health plans, including Medicare

• Medical and case management records (except psychotherapy notes)

• Any other records that have information that doctors or health plans use to make decisions about you

You may have to fill out a health information “request” form and pay a cost-based fee for copies. Your providers or plans should tell you about the fee when you make the request. If they don’t, you should ask. The fee can only be for the labor to make the copies, copying supplies, and postage (if needed). In most cases, you shouldn’t be charged for viewing, searching, downloading, or sending your information through an electronic portal.

Generally, you can get your information on paper or electronically. If your providers or plans store your information electronically, they generally must give you electronic copies, if that’s your preference.

You have the right to get your information in a timely manner, but it may take up to 30 days to fill the request.

For more information, visit hhs.gov/hipaa/for-individuals/guidance-materials-forconsumers.

If you need help getting and using your health records, the Office of the National Coordinator (ONC) in the U.S. Department of Health and Human Services (HHS) created “The Guide to Getting & Using Your Health Records.” This guide can help you through the process of getting your health records and show you how to make sure your records are accurate and complete, so you can get the most out of your health care. Visit healthit.gov/how-to-get-your-health-record to view the guide.

How does Medicare use my personal information?

Medicare protects the privacy of your health information. On pages 103 - 104 in your Medicare & You Handbook describe how Medicare may use and give out your information, and explain how you can get this information.

Source: Medicare & You Handbook 2022: Section 8, Pg. 97-102