Enrolling in Medicare gives you access to important health coverage, but it also gives you certain legal rights and protections. Whether you’re new to Medicare or have been enrolled for years, understanding these rights can help you get the care you need, avoid unexpected costs, and resolve issues with confidence.
At Wise Insurance, a trusted Medicare insurance broker, we believe every Medicare beneficiary in Texas and across the country deserves to feel informed and empowered. Here’s what you should know about your rights under Medicare.
You Have the Right to be Treated With Respect
As a Medicare beneficiary, you are entitled to be treated with dignity, respect, and fairness. This applies to your interactions with Medicare providers, insurance companies, hospitals, and other healthcare professionals. You cannot be discriminated against based on your race, color, national origin, disability, age, religion, or sex.
If you ever feel that you’ve been treated unfairly or discriminated against, you can file a complaint with the Office for Civil Rights at the U.S. Department of Health and Human Services.
You Have the Right to Timely Access to Care
Medicare ensures that you have access to medically necessary services. Whether you’re enrolled in Original Medicare or a Medicare Advantage plan, your provider is required to give you timely care. This means you shouldn’t face excessive delays in getting appointments, procedures, or prescriptions.
If you believe you’re being denied care or facing long delays, you have the right to ask questions, file an appeal, or request a second opinion.
You Have the Right to Choose Your Provider
If you have Original Medicare, you can visit any doctor, specialist, or hospital in the United States that accepts Medicare. You do not need referrals, and you have the freedom to change providers at any time.
If you’re enrolled in a Medicare Advantage plan, your provider choices may be more limited based on your plan’s network. However, you still have the right to know which providers are available and to receive care from qualified professionals within the network.
You Have the Right to Understand Your Coverage
Medicare beneficiaries have the right to receive clear, accurate, and timely information about their coverage, costs, and benefits. This includes:
- A written summary of benefits each year
- An Explanation of Benefits (EOB) after receiving care
- The right to ask questions about your plan at any time
If you are confused about a bill, denied service, or unclear about what your plan covers, you can contact your Medicare plan provider or Medicare directly at 1-800-MEDICARE.
At Wise Insurance, we also provide one-on-one support to help you review your coverage and answer any questions you may have.
You Have the Right to File an Appeal
If Medicare or your Medicare Advantage plan denies coverage for a service or item you believe you need, you have the right to appeal the decision. This applies to:
- Denied services
- Denied medications
- Inpatient hospital stays
- Discharges from healthcare facilities
You can request a fast appeal if your health is at immediate risk. Each level of appeal gives you another chance to present your case, and many appeals are successful when beneficiaries provide supporting documentation from their doctors.
You Have the Right to Privacy
Your medical records and personal health information are protected under federal law. This means your information cannot be shared without your consent, except in specific situations like emergencies or when required by law.
If you suspect that your personal health information has been improperly accessed or shared, you can file a complaint with the U.S. Department of Health and Human Services.
You Have the Right to Protection from Fraud and Abuse
Medicare fraud costs billions of dollars each year and can lead to unnecessary services, false charges, or stolen identities. As a Medicare beneficiary, you have the right to be protected from fraudulent activity and to report suspicious behavior.
Watch for red flags such as:
- Being billed for services you didn’t receive
- Offers for “free” equipment or services that require your Medicare number
Pressure to accept unnecessary treatments or supplies
You can report suspected fraud to Medicare at 1-800-MEDICARE or to your local Senior Medicare Patrol (SMP).
You Have the Right to Receive Help
You don’t have to navigate Medicare alone. If you need help understanding your rights, comparing plans, or resolving issues, there are resources available to support you:
- Medicare: 1-800-MEDICARE or medicare.gov
- State Health Insurance Assistance Programs (SHIPs)
- Your Medicare Advantage or Part D plan’s customer service
- A trusted local advisor, like Wise Insurance
We take pride in helping Texans make sense of their Medicare options, avoid common pitfalls, and get the care they deserve.
Know Your Rights and Use Them
Understanding your Medicare rights isn’t just about knowing the rules – it’s about protecting your health, your finances, and your peace of mind. When you know what you’re entitled to, you’re better equipped to advocate for yourself and make informed decisions.
If you ever feel uncertain or overwhelmed, Wise Insurance is here to help. Our advisors can guide you through your options, explain your rights in plain language, and help you resolve any issues that may arise. Your health, your rights, and your future matter – let us help you protect them.
Emily Trevino, Senior Managing Partner at Wise Insurance, leverages her extensive background in biology and business finance to master Medicare, health insurance, and retirement planning. With over a decade in the field, Emily has co-authored “Medicare Breakdown – The Alphabet Soup of Medicare,” marking her as a pivotal figure in insurance education. Her commitment extends through active participation in the National Association of Benefits and Insurance Professionals (NABIP) and speaking at major industry events. Emily’s drive for community service and personal resilience shines through her adventurous pursuits and dedication to societal well-being. Connect with Emily on LinkedIn to explore the future of informed insurance decisions.
