Your Coverage & Care
Your Coverage & Care
 
Understanding Your Coverage

Know Your Rights - Under Medicare

As a healthcare consumer, your rights are protected by the Affordable Care Act. There are additional rights and protections if you have health coverage through Medicare.

The Medicare program has evolved since it was first introduced in 1965, but important rights and protections remain. If you have Medicare, you have the right to the following:

  • Receive all the health care services that the law says you can receive.
  • Have access to doctors, specialists, and hospitals.
  • Get Medicare-covered services in an emergency.
  • File a complaint (or grievance) about your quality of care.
  • Request a review (appeal) certain decisions about health care payment, coverage of services, or prescription drug coverage.

If you’re in a Medicare Advantage Plan (Part C)  that is managed by a private insurer, in addition to the rights and protections for all people with Medicare, the following apply:

  • If you have a complex or serious medical condition, a treatment plan lets you directly see a specialist within the plan as many times as you and your doctor think you need.
  • Women have the right to go directly to a women's health care specialist without a referral within the plan for routine and preventive health care services.

Learn additional information and resources to help you protect your rights under Medicare.

Learn more about the services that Medicare will not pay for.

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