Medicare Rights and Protections
If you know your Medicare Rights and Protections you will know how to handle the situations below. These are:
Your Medicare Advantage plan denies a request from your doctor to treat you for a specific health issue. What if you have Original Medicare and the same thing happens?
Your doctor prescribes you a medication that is covered by Medicare but is not in your prescription drug plan’s formulary and your plan won’t cover it. What will you do?
You receive a bill from your doctor/hospital that you didn’t expect and it doesn’t make sense to you.
Your doctor is ready to sign release paperwork from the hospital. You are to be moved to skilled nursing care this afternoon. Your insurance company comes back and tells you this coverage requires ‘prior authorization’ and they will get back to you within 72 hours.
Answers to these situations and others are contained in the Centers for Medicare and Medicaid Services (CMS) course titled ‘Medicare Rights and Protections’. This is available in PowerPoint format. This page will describe the course and how to download/view the material. It is located on the CMS.gov website. We encourage you to take the time to familiarize yourself with your Medicare rights and protections before you find yourself in unfamiliar situations.
Why do this?
So you will be aware of your Medicare Rights and Protections. These rights are available whether you’re enrolled in Original Medicare, a Medicare Advantage Plan (like a Health Maintenance Organization or Preferred Provider Organization), another Medicare health plan (like a Medicare Cost Plan or Program of All-Inclusive Care for the Elderly), or a Medicare Prescription Drug Plan. We feel knowing these rights and protections before you will need them will put in a position to know how to both recognize these issues and know how to find help resolving them. Learning this now could easily save anxiety if any of these issues come up.
Medicare Rights and Protections … highlights of what you will learn
Your Medicare rights and access to care
Your claims and appeal rights
Your rights to file complaints (grievances)…and who to contact
Your rights when you have Original Medicare
Appeal rights and how to do it when you are on Original Medicare
This includes how to get a ‘fast appeal’
The different types of liability notices you can get with Original Medicare; for example ‘An advanced beneficiary notice of noncoverage’.
Your rights if you have a Medigap plan
Your rights with Medicare Advantage and other types of Medicare health plans
Your coverage and appeal rights with Medicare Health plans
Your rights when filing Medicare health plan appeals
Medicare prescription drug plans
Access to covered drugs
Learn about which medication drug classes are required for all plans
Learn how to get an answer within 24 hours from your plan on a ‘coverage determination’
Learn the rules that apply to managed access to medications
Learn when plans must grant formulary exceptions
How to request a Part d appeal
Personal Health information—plan and provider rules for disclosing such
Your rights in different provider settings (hospital, skilled nursing, etc.)
Learn about the ‘fast appeal process’ for ‘Notice of Medicare non-coverage
Learn about Medicare privacy practices
We encourage you to learn about Medicare Rights and Protections
Many people don’t react well to surprises when it comes to health care, especially when it comes to quality of service issues or denial of coverage from providers or your insurance company. Knowing where to get specific details on your Medicare Rights and Protections before these issues come up should help you find a way to a timely resolution. We encourage you to take the time in the near future to review this course. We know you may not remember all of this material, but going through the course before issues come up should create enough of an impression that you will remember where the course is and how to find answers when you need them.
If you are a resident of Idaho and want help understanding Medicare, the differences between your health and prescription drug plan choices or help to make changes to your present plans, please call us. We only work with Idaho residents are licensed with all plans available to you so plan/insurance company is not an issue.
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