You have important rights in Medicare, no matter which plan you have. Compared to most private health insurance, Medicare has some of the best consumer protections.

The Medicare plans include:

• The Original Medicare Plan
• Medicare Advantage Plans, such as
  • Medicare Health Maintenance Organization (HMO)
  • Medicare Preferred Provider Organization (PPO)
  • Medicare Private Fee-for-Service (PFFS) Plans
• The Medicare Prescription Drug Plan

In Medicare, you have the right to:

• Be respected
• Be protected against discrimination
• Get information and assistance
• Get health care from doctors and hospitals
• Know and participate in treatment choices
• File complaints
• Have your personal information kept private

You can find more details about these and other Medicare rights in Your Medicare Rights and Protections (Adobe Acrobat Required) on the Medicare Web site.

Be Respected

You have the right to be treated with dignity and respect at all times.

Be Protected Against Discrimination

You have the right to be treated fairly and receive good care no matter what your race, color, national origin, sex, disability, age or religion.

If you feel that you have been treated unfairly, call the U.S. Office for Civil Rights in your state.

Get Information and Assistance

You have the right to get the information you need to make good health care decisions. This information includes:

• What benefits are covered
• What Medicare will pay
• What you will pay
• How to file a complaint

You also have the right to get your questions answered. Get information and help you can trust from the Medicare Web site and through the Medicare helpline, 1-800-633-4227. You can also call your State Health Insurance Assistance Program (SHIP). SHIPs offer free health insurance counseling.

Get Health Care From Doctors and Hospitals

You have the right to get health care from doctors and hospitals. In the Original Medicare Plan, you can go to any doctor or hospital in the country that accepts Medicare. Most do. In a Medicare Private-Fee-for-Service plan, you can go to any doctor or hospital who agrees to the plan’s terms.  In either Original Medicare or a Medicare PFFS, you can also switch doctors for any reason.

In a Medicare HMO, you generally get care from doctors who are part of the plan's network. You choose a primary care doctor from the plan's network. Your primary care doctor oversees your care, sends you to specialists, and admits you to the hospital, if needed. However, if you have a complex or serious medical condition, you can get a treatment plan from your primary doctor that allows you to go directly to a specialist.

In a Medicare PPO, you can go to doctors or hospitals outside the plan's network, but you will pay more. However, both Medicare HMOs and PPOs must pay for you to see a doctor outside the plan's network, if no doctor in the network can give you the service you need. You have the right to get emergency care when and where you need it, no matter which Medicare plan you are in. An emergency is when you think your health is in serious danger from an injury, sudden illness or an illness that is getting worse. 

If you are in a Medicare Advantage plan, such as a Medicare HMO or a Medicare PPO, you do not need permission before getting emergency care.

Know and Participate in Treatment Choices

You have the right to talk with your doctor about your health care and all your treatment choices. You have a right to hear this information in a way that you can understand. If you don't speak or understand English, you have a right to an interpreter who can help you talk to your doctor. You also have the right to get health care that is sensitive to your culture.

You have the right to be a part of any decision about your health care. You can ask someone else, such as a friend or relative, to help you with your decision.

File Complaints

You have the right to file a complaint with your Medicare plan. There are two kinds of complaints; appeals and grievances.

• Appeals
  There are times when your Medicare plan may refuse to provide a service or reduce or end care you think you need. You always have the right to ask the plan to review its decision by filing an appeal. If you think you need the care, don't take "no" for a final answer. Many appeals are successful.
• Grievances
  No matter which Medicare plan you are in, you have the right to file a grievance if you think you are not getting quality health care. If you want to complain about the quality of your care, call the Quality Improvement Organization (QIO) in your state. Quality Improvement Organizations are groups of practicing doctors paid by Medicare to check and improve the care given to people with Medicare.
  
  If you are in a Medicare HMO or PPO, you can also file a grievance if you have complaints about the way care is given. For example, you can file a grievance if you have problems:
  • reaching your doctor or the plan by phone
  • coping with staff behavior
  • getting an appointment to see your doctor
  • getting a referral to a specialist
  • receiving a medical service

Have Your Personal Information Kept Private

You have the right to have your personal information, such as your address and telephone number, kept private. If you are asked for this information, you have a right to know:

• Why it is needed and how it will be used
• Whether you must provide the information
• What happens if you don't give the information

Your state may have additional privacy laws that protect your personal information. Check with your State Health Insurance Assistance Program (SHIP) to learn more about the laws in your state.

You also have the right to talk to your doctor in private and have your personal health information kept confidential. A new privacy rule, going into effect in April 2003, will give you more access to your medical records and more control on how your health information is used.

Additional Resources

Medicare Contacts
Search for contacts by topic or the name of the organization.

Medicare Rights Center (MRC)
An independent source of Medicare information for consumers. Publications available for a fee include "Your Appeal Rights: Getting the Most from Medicare," and "Medicare HMOs: Your Rights and Responsibilities"

Center for Medicare Advocacy
Education, publications, advocacy, and legal help.