Your rights in a Medicare Advantage Plan or other Medicare health plan

If you’re in a Medicare Advantage Plan (like an HMO or PPO) or other Medicare health plan, in addition to the rights and protections for all people with Medicare, you have the right to:

• Choose health care providers within the plan, so you can get the health care you need.
• Get a treatment plan from your doctor.
  • 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.
  • Women have the right to go directly to a women's health care specialist without a referral within the plan for routine and preventive health care services.
• Know how your doctors are paid.
  • When you ask your plan how it pays its doctors, the plan must tell you.
  • Medicare doesn't allow a plan to pay doctors in a way that could interfere with you getting the care you need.
• Request an appeal to resolve differences with your plan.
• File a complaint (called a "grievance") about other concerns or problems with your plan.
• Get a coverage decision or coverage information from your plan before getting services.

If you want to know more about your rights and protections, including rights and protections you may have in addition to those mentioned here, read your plan’s membership materials, or call your plan.