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Your Medicare Rights and Protections


As a beneficiary, you are entitled to know about your Medicare Rights and Protections. Each of these resources has a different purpose, and various circumstances call for the use of each.

So, where do you start when you have concerns? We’re here to make sure you’re familiar with your Medicare rights and who to contact in specific situations.

What Are Your Medicare Rights and Protections?

Part of your rights and protections is the knowledge of your Medicare costs, Medicare Advantage vs Medigap options, and Original Medicare coverage. Further, it’s your right to know how to file an appeal. Also, it’s smart to report because your issue could be a common complaint. You can also obtain free assistance and resources that ensure you have a voice. If adequate care at a facility isn’t being met, you can file a report. Next, we explain the types of assistance available and how you can get help.

What is the Medicare Beneficiary Ombudsman?

When you have an inquiry and Medicare isn’t much help, the Medicare Beneficiary Ombudsman (MBO) is your resource. Finally, they will ensure the resolution of your concerns.

The MBO ensures the following is accessible to recipients:

  • Information to make the right decisions
  • Knowledge of rights and protections
  • Procedure for resolution of issues

To reach the Medicare Beneficiary Ombudsman, ask a representative at 1-800-MEDICARE to send your question or complaint to the MBO. They will address your concern. Then, the Ombudsman provides an annual report to Congress each year to improve the program.

What is the State Health Insurance Assistance Programs?

The State Health Insurance Assistance Programs (SHIPs) provides local health insurance counseling to beneficiaries and their families. SHIPs help with complaints, appeals, and a range of questions about Medicare. Your local SHIP allows you to speak with someone in person about costs, eligibility, and coverage. Also, they teach you about your Medicare rights.

If you plan to change status on a Part C or Part D plan, SHIP can help with counseling. Assistance can be helpful during the Annual Enrollment Period. To locate a SHIP near you, use the locator at the SHIP National Network website.

What is the Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO)?

If you have a complaint about the quality of the care, you’ll submit a form to your BFCC-QIO. These state organizations also help with grievances, filing appeals, and reviews for medical necessity.

You can find your state’s BFCC-QIO on the contact page of Medicare.gov.

Your State Survey Agency Can Help With Medicare Rights and Protections

State Survey Agencies make sure health care facilities participating in government funding meet health and safety standards. Contact your State Survey Agency in the case of unsuitable care. You can also report conditions at such facilities that don’t reach an adequate standard of safety.

The State Survey Agency addresses your concerns and complaints. The information for your State Survey Agency is also available on the contact information page of Medicare.gov.

FAQ’s

Who can help me with Medicare Questions?
If you’re looking for Medicare specific questions, you can contact Medicare. If you want information on a current policy you can contact your plan. But, if you want help finding a new policy you can contact us, here at MedicareFAQ.com.
Does Medicare cover health care advocates?
Federal insurance programs like Medicare and Medicaid provide access to no-cost insurance counselors.
Can Medicare deny treatment?
Yes, Medicare has the right to deny treatment that isn’t medically necessary or services that don’t fall under their scope of coverage. If you think Medicare wrongfully denied your coverage, then you can file an appeal.

How to Get Information About Your Medicare Rights and Protections

To get more information about your Medicare rights and protections got to Medicare.gov or your SHIP agency. If you need help selecting a Medicare Supplement plan, give us a call or complete our online rate form today.

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Lindsay Engle

Lindsay Engle is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

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