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As a Medicare beneficiary you have Medicare rights. Whether you receive your Medicare benefits through Original Medicare or a Medicare Advantage plan, you have certain rights and protections that are meant to protect you when you receive health care, including:
Ensuring that you have access to the health care services that the law says you’re entitled to
Protecting you from unethical practices such as discrimination
Protecting your privacy
Know Your Medicare Rights
As a Medicare beneficiary “you have the right to be treated fairly, understand the information you get, and keep your personal information safe.”
In addition, you have the right to:
Be treated with courtesy, dignity, and respect at all times.
Have your personal and health information kept private.
Have your questions about Medicare answered.
Get clear and simple information about Medicare to help you make health care decisions, including what services are covered.
Medicare and treatment choice information presented in a language that you can understand (contact your plan to request information in a specific language).
Medicare and treatment choice information in an accessible format such as large print (contact your plan to make a request for a specific accessible format).
Be treated without discrimination. Every company or agency that signs up to work with Medicare is legally required to follow discrimination laws. This means that you cannot be treated differently because of your race, color, national origin, disability, age, religion, or sex.
Access to doctors, specialists, and hospitals for health services that are medically necessary.
Get emergency care for Medicare covered services when and where you need it.
Receive health care services in a language you understand and in a culturally sensitive way. Visit hhs.gov/ocr for information about getting health care services in a language other than English.
Participate in treatment decisions.
Get a decision about health care payment, coverage of services, or prescription drug coverage.
Request a review (appeal) about health care payments, coverage of items, services, and prescription drugs.
File a complaint (grievance) about the quality of your care or other service issues with your Medicare provider. For more information on filing a complaint, visit Medicare.gov/appeals.
Have access to your personal health information* (either electronically or in the form of a paper copy) from health care providers who bill Medicare for the services they provided and health plans that cover your care, including Medicare. Note: you may be charged a fee to cover the expenses associated with downloading, printing, and mailing paper copies of your records.
Have the right to get your personal health information in a timely manner (up to 30 days).
Request that a third-party such as a health care provider who treats you, a legal representative, or a family member have access to your personal health information.
*Personal health information includes:
Claims and billing records
Information about your enrollment in health plans, including Medicare plans
Medical and case management records
Other records that doctors or health plans use to make decisions about you
You can learn more about your medical rights under HIPAA.
Additional rights for those enrolled in Original Medicare
If you have Original Medicare, you also have the following rights:
Receive care from any doctor or specialist that participates in Medicare or from any Medicare-certified hospital.
Access to specific information, notices, and appeal rights that are designed to help beneficiaries resolve issues when Medicare may not or doesn’t pay for health care.
Request an appeal of health care coverage or payment decisions.
Purchase a Medigap plan under certain circumstances (Guaranteed Issue Rights)
Additional rights for seniors enrolled in Medicare Advantage plans
If you are enrolled in a Medicare Advantage plan, you also have the following additional rights:
Choose health care providers within the plan network.
Get a treatment plan from your healthcare provider.
Request to know what your doctors are paid.
Get a coverage decision or coverage information from your plan before receiving services.
Request an appeal to resolve differences with the plan.
File a complaint about other concerns or problems with the plan.
Rights for seniors with prescription drug plans through Part D or Medicare Advantage
If you are enrolled in a Medicare drug plan, you also have the following rights:
Request a coverage determination or appeal to resolve differences with your plan.
Privacy for your health and prescription drug information.
How to get help if you are the victim of discrimination or your Medicare rights are violated
If you think you've been discriminated against as a Medicare beneficiary, you can file a complaint with the Department of Health and Human Services, Office for Civil Rights. Their phone number is 1‑800‑368‑1019.
The Medicare ombudsman can help with all other types of Medicare complaints. Visit go.cms.gov/ombudsman or call 1‑800‑MEDICARE (1-800-633-4227). TTY users can call
1-877-486-2048.
Your Hawaii State Health Insurance Assistance Program (SHIP) or local Medicare agent can help you with any questions about your Medicare rights and protections and choosing the right Medicare plan for you.
Our independent insurance agents are dedicated to assisting people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed. Because we represent all the major Medicare Advantage and supplement plans in Hawaii, we are able to offer unbiased advice; all at no cost to our clients.
At PBC, our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.