What Should I do if Medicare Denies a Claim?

You have the right to appeal any Medicare coverage denial. Start by requesting a redetermination from the Medicare contractor within 120 days of receiving your Medicare Summary Notice. Keep all documentation and act promptly, as appeal deadlines are strict.

Can a Doctor Refuse to See Me Because I Have Medicare?

Doctors who accept Medicare assignment cannot refuse to treat you based solely on your Medicare coverage. However, some doctors opt out of Medicare entirely and can decline Medicare patients. Always confirm a provider accepts Medicare before your appointment.

What is a Medicare Summary Notice (MSN)?

A Medicare Summary Notice is a statement sent every three months that lists all the services billed to Medicare on your behalf. Review it carefully for errors or services you did not receive, as these could indicate billing fraud.

How do I Contact My State Health Insurance Assistance Program (SHIP)?

SHIP provides free Medicare counseling in every state. You can find your local SHIP by visiting shiphelp.org or by calling 1-800-MEDICARE (1-800-633-4227).

What is an Advance Beneficiary Notice (ABN)?

An ABN is a written notice a provider must give you before providing a service that Medicare may not cover. It informs you that you may be responsible for payment. You must sign the ABN to acknowledge you understand you may have to pay.

What Should I do if Medicare Denies a Claim?

You have the right to appeal any Medicare coverage denial. Start by requesting a redetermination from the Medicare contractor within 120 days of receiving your Medicare Summary Notice. Keep all documentation and act promptly, as appeal deadlines are strict.

Can a Doctor Refuse to See Me Because I Have Medicare?

Doctors who accept Medicare assignment cannot refuse to treat you based solely on your Medicare coverage. However, some doctors opt out of Medicare entirely and can decline Medicare patients. Always confirm a provider accepts Medicare before your appointment.

What is a Medicare Summary Notice (MSN)?

A Medicare Summary Notice is a statement sent every three months that lists all the services billed to Medicare on your behalf. Review it carefully for errors or services you did not receive, as these could indicate billing fraud.

How do I Contact My State Health Insurance Assistance Program (SHIP)?

SHIP provides free Medicare counseling in every state. You can find your local SHIP by visiting shiphelp.org or by calling 1-800-MEDICARE (1-800-633-4227).

What is an Advance Beneficiary Notice (ABN)?

An ABN is a written notice a provider must give you before providing a service that Medicare may not cover. It informs you that you may be responsible for payment. You must sign the ABN to acknowledge you understand you may have to pay.

Your Medicare Rights and Protections | MedicareFAQ

As a Medicare beneficiary, you are entitled to a set of rights and protections guaranteed by federal law. These protections cover everything from your right to receive necessary care to your right to appeal a coverage denial. Knowing your rights empowers you to advocate for yourself and get the most out of your Medicare coverage.

Your Right to Access Care

Medicare guarantees you the right to access medically necessary care. You have the right to see any provider who accepts Medicare, get emergency care anywhere in the United States, and receive care without discrimination based on race, color, national origin, disability, age, or sex. Providers cannot refuse to treat you solely because you have Medicare.

Your Right to Be Informed

You have the right to receive clear, written information about your coverage, costs, and care options. This includes the right to receive an Advance Beneficiary Notice (ABN) before receiving a service that Medicare may not cover, so you can decide whether to proceed and accept financial responsibility. Hospitals must also provide you with a written notice called the "Important Message from Medicare" that explains your rights as a hospital patient.

Your Right to Appeal Coverage Decisions

If Medicare or your Medicare plan denies coverage for a service, you have the right to appeal that decision. The appeals process has five levels: redetermination by the Medicare contractor, reconsideration by a Qualified Independent Contractor (QIC), hearing before an Administrative Law Judge (ALJ), review by the Medicare Appeals Council, and judicial review in federal district court. You must file your appeal within specific timeframes, so act promptly when you receive a denial.

Important: Keep All Medicare Notices

Always keep copies of your Medicare Summary Notices (MSNs), Explanation of Benefits (EOBs), and any written coverage decisions. These documents are essential if you need to file an appeal.

Your Right to a Fast Appeal (Expedited Review)

If you are a hospital inpatient and your doctor says you are ready to be discharged but you disagree, you have the right to request an immediate review by a Peer Review Organization (PRO) - also called a Quality Improvement Organization (QIO). If you request this review before you leave the hospital, Medicare will continue to cover your stay while the review is conducted, and you will not be responsible for those costs even if the QIO ultimately sides with the hospital.

Your Right to Privacy and Confidentiality

Your Medicare information is protected under federal privacy laws, including the Health Insurance Portability and Accountability Act (HIPAA). Medicare and your healthcare providers cannot share your personal health information without your authorization, except as permitted by law. You have the right to request and review your medical records and to ask for corrections if information is inaccurate.

Your Right to Be Free from Discrimination

Medicare prohibits discrimination in the delivery of healthcare services. Providers who participate in Medicare must treat all beneficiaries equally regardless of race, color, national origin, disability, age, sex, or religion. If you believe you have been discriminated against, you can file a complaint with the Office for Civil Rights at the U.S. Department of Health and Human Services.

Your Right to Report Fraud and Abuse

Medicare fraud costs taxpayers billions of dollars each year and can compromise the quality of care beneficiaries receive. You have the right - and are encouraged - to report suspected Medicare fraud to the Office of Inspector General (OIG) at 1-800-HHS-TIPS or online at oig.hhs.gov. You can also contact your State Health Insurance Assistance Program (SHIP) for free, unbiased counseling about your Medicare rights.

How a Medigap Plan Protects Your Financial Rights

While Original Medicare provides strong coverage, it does not cap your out-of-pocket costs. A Medicare Supplement (Medigap) plan can protect you from unexpected expenses by covering costs like the Part A deductible, Part B coinsurance, and excess charges. Medigap plans are standardized by federal law, so the benefits for each plan letter are identical regardless of which insurer you choose.

Your Medicare Rights and Protections