Understanding Your Medicare Rights and Protections

A list of Medicare rights has been put in place to ensure seniors receive the benefits to which they’re entitled.

Medicare Rights, to Name a Few

  • Freedom from discrimination
  • Respectful treatment that preserves one’s dignity
  • Complete and understandable information regarding Medicare benefits and healthcare providers
  • Access to doctors, specialists, and hospitals
  • Emergency services
  • A fast appeal in the case of service denial
  • Complaint process

Further, there are Medicare rights that are specific to the different parts of Medicare

Additionally, there are numerous resources available to help you obtain services and procedures due you under this extensive list of Medicare rights. These resources include:

  • The Medicare Beneficiary Ombudsman
  • SHIP – Your State Health Insurance Assistance Program
  • CAO – The Competitive Acquisition Ombudsman
  • BFCC-QIO – The Beneficiary Family Centered Care Quality Improvement Organization
  • State Survey Agency

The Medicare Beneficiary Ombudsman

The Medicare Beneficiary Ombudsman works with Congress and the Secretary of Health and Human Services to determine how Medicare works, or doesn’t, in order to improve the quality of benefits seniors receive. This office can help you with information requests as well as with complaints. If you have contacted Medicare and have not had your issue resolved, phone Medicare at 1-800-633-4227 and request that your inquiry or complaint is sent on to the Medicare Beneficiary Ombudsman. The staff in that office will work on making sure your issue is resolved.

SHIP – Your State Health Insurance Assistance Program

SHIP offices work on a local level to provide free information and counseling to help you with:

  • Any Medicare-related question including benefits to which you may be entitled, premiums, copayments, coinsurance, and deductibles
  • Complaints
  • Appeals
  • Information regarding joining or leaving Medicare Part C or Medicare Part D

You can find the phone number of your local SHIP office at this link.

CAO – The Competitive Acquisition Ombudsman

The CAO is the resource you would access to find resolution to issues relating to durable medical equipment (DME). This office deals with inquiries, problems, and complaints from both Medicare recipients and suppliers and ensures that the complaint is resolved. The office of the CAO can be reached through Medicare at 1-800-633-4227.

BFCC-QIO – The Beneficiary Family Centered Care Quality Improvement Organization

The quality of healthcare services, as well as their cost and effectiveness, falls under the domain of the BFCC-QIO. This office can help you with:

  • Quality of care investigations
  • Medical necessity evaluations
  • Complaints and grievances
  • Filing appeals to extend coverage if you feel your in-hospital or non-hospital care has ended too soon

You can find the contact information for the BFCC-QIO in your state at this link.

State Survey Agency

It is the job of the State Survey Agencies to inspect and oversee hospitals and facilities that provide care for Medicare recipients. They investigate complaints or improper medical care, abusive or neglectful treatment, unsafe conditions, or poor dietary care.

Ensure that you receive all the benefits to which you’re entitled under Medicare by being an educated consumer.

An educated consumer receives the most benefits from their Medicare coverage.

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