Sus derechos

You have the right to be treated fairly, understand the information you get, and keep your personal information safe.

If you have Medicare

You have the right to be:

  • Treated with courtesy, dignity and respect at all times.
  • Protected from discrimination. Every company or agency that works with Medicare must obey the law. They can't treat you differently because of your race, color, national origin, disability, age, religion, or sex.

You have the right to have:

  • Your personal and health information kept private.
  • Access to doctors, specialists, and hospitals for medically necessary services.

You have the right to get:

  • Medicare-covered services in an emergency.
  • Information in a way you understand from Medicare, health care providers, and, under certain circumstances, contractors.
  • Information about your treatment choices in clear language that you can understand, and participate in treatment decisions.
  • Medicare information and health care services in a language you understand.
  • Your Medicare information in an accessible format, like braille or large print.
  • Answers to your Medicare questions.
  • A decision about health care payment, coverage of items and services, or drug coverage.

If you need plan information in a language other than English, or in an accessible format, contact your plan.

When you or your provider files a claim, you’ll get a notice letting you know what will and won’t be covered. This notice may come from:

  • Medicare
  • Su Plan Medicare Advantage (Parte C) u otro plan de salud de Medicare
  • Su Plan de medicamentos recetados de Medicare para la cobertura de medicamentos de Medicare (Parte D)

If you disagree with the decision on your claim, you have the right to file an appeal. You may:

  • Solicitar una revisión (apelación) de ciertas decisiones con respecto al pago del cuidado de salud, cobertura de artículos o servicios, o cobertura de medicamentos recetados.
  • File complaints (sometimes called “grievances"), including complaints about the quality of your care. You may decide to do this if you have concerns about the quality of care and other services you get from a Medicare provider.

Access to your personal health information

Por ley, usted o su representante legal suelen tener derecho a ver u obtener copias de su información de salud personal de los siguientes grupos:

  • Health care providers who treat you and bill Medicare for your care
  • planes de salud que pagan por su cuidado, como Medicare.

These types of personal health information include:

  • Registros de reclamaciones y facturación
  • Información relacionada con su inscripción en los planes de salud, inclusive Medicare
  • Medical and case management records
  • Other records that doctors or health plans use to make decisions about you

Generally, you can get your information on paper or electronically. If your providers or plans store your information electronically, they must give you electronic copies, if you ask for them. You have the right to get your information in a timely manner, but it may take up to 30 days to get a response. Keep in mind, if your information is electronic, you also have the right to have it sent to a third party of your choosing. A third party may be a:

  • Health care provider who treats you
  • Miembros de la familia
  • Researcher

You may have to fill out a form to request copies of your information and pay a fee. This fee can’t be more than the total cost of:

  • Labor for copying the information requested
  • Supplies for creating the copy
  • Postage (if you ask your health care provider to mail you a copy)

En la mayoría de los casos, no deberían cobrarle por ver, buscar, descargar o enviarle información a través de un portal electrónico.

Get more information about your rights under HIPAA.

More rights based on your coverage

When you have Medicare, there are rules that protect your right to fair treatment, access to helpful information, and the privacy of your personal and health records. Find out more about your rights and protections.

Medicare original

If you have Original Medicare, you can:

  • Consultar cualquier médico o especialista (incluidos los especialistas de mujeres) o asistir a cualquier hospital certificado por Medicare, que participe en Medicare.
  • Get certain information, notices, and appeal rights. These help you resolve issues when Medicare may not (or doesn't) pay for your health care.
  • Solicitar una apelación de cobertura de salud o decisiones de pago.
  • Buy Medicare Supplement Insurance (a Medigap policy).
Plan Medicare Advantage u otro plan de salud de Medicare

You have the same rights and protections as all people with Medicare. You also have the right to:

  • Elegir los proveedores de salud dentro del plan.
  • Recibir un plan de tratamiento de su médico.
    • 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.
    • Las mujeres tienen derecho a consultar directamente un especialista en cuidado de salud de mujeres sin referidos dentro del plan para servicios de salud de rutina y preventivos.
  • Saber cómo se les paga a los médicos.
    • Cuando pregunta a su plan cómo les paga a los médicos, el plan debe decirle.
    • Medicare no permite que un plan les pague a los médicos de alguna manera que pueda interferir con el cuidado de salud que usted necesita.
  • Solicitar una apelación para resolver diferencias con su plan.
  • Presentar una queja (llamada "queja formal") por otras inquietudes o problemas con su plan.
  • Recibir una decisión de cobertura o información de cobertura de su plan antes de recibir los servicios.

To learn more about your rights and protections, read your plan’s membership materials, or call your plan.

Si tiene un plan de medicamentos de Medicare o un plan Medicare Advantage con cobertura de medicamentos

You have the same rights and protections as all people with Medicare. You also have the right to:

  • Get a written explanation for drug coverage decisions (called a “coverage determination”) from your Medicare drug plan.
    • A coverage determination is the first decision your Medicare drug plan (not the pharmacy) makes about your benefits. This can be a decision about if your drug is covered, if you met the plan’s requirements to cover the drug, or how much you pay for the drug.
    • You’ll also get a coverage determination decision if you ask your plan to make an exception to its rules to cover your drug.
  • File a complaint (called a "grievance") with the plan. A grievance is a complaint about the way your Medicare health or drug plan is giving care.
  • Have the privacy of your Medicare health and drug information protected.

If you have Medicare drug coverage, your plan will send you information that explains your rights. Call your plan if you have questions.