Medicare Advantage Plans: Rights and Protections

All Medicare recipients, regardless of plan, are entitled to certain specific rights. However, Medicare Advantage Plans also have additional rights and protections. 

For instance, you will usually have the right to your choice of, and access to, health care providers.  This means that, in many Medicare Advantage Plans, you are able to choose health care providers within your plan in order to get necessary care.  In situations where you have a serious medical condition, you have the right to get a treatment plan from your doctor, which will allow you to see a specialist (within your plan) as many times as needed.  You also have the right to know how your plan pays your doctors. The method of payment should allow you to get the required medical care. 

Like in your basic Medicare rights, Medicare Advantage plans give you the right to a fair appeal process if you disagree with a coverage policy or decision.  You have the right, as well, to a fast appeal in-hospital, and if you believe you are being discharged too soon, you do have that appeal option.  You also have the right to file a grievance over any concerns you are having with your Plan.  Along with these appeal rights, you have the right to have the privacy of your health information protected. 

 If you have questions for your Medicare Advantage Plan, you have the right to call them.  They should be willing to answer any coverage questions you have and give you additional information.

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