Your Rights as a Member

As a member of an Elderplan or HomeFirst health plan, you have important rights and protections related to your health care, privacy, access to services, and participation in decisions about your care.

The rights that apply to you depend on the type of plan you are enrolled in. Some members have rights under Medicare, some have rights under Medicaid, and some have additional rights related to long-term care services and supports.

This section provides information about your rights and responsibilities, where to go for help, and the options available to you if you have a concern, complaint, or appeal.

Understanding Your Rights

All members have the right to:

• Be treated with dignity and respect.
• Receive information in a language and format they can understand.
• Participate in decisions about their care.
• Have their personal health information protected.
• Access medically necessary covered services.
• File complaints and appeals when they disagree with a decision.
• Appoint someone to act on their behalf.
• Receive care without discrimination.

Additional rights may apply depending on whether your plan includes Medicare benefits, Medicaid benefits, or long-term care services and supports.

Medicare Rights & Responsibilities

Members enrolled in Medicare Advantage plans have rights related to Medicare-covered medical services, prescription drug coverage, appeals, grievances, emergency care, advance directives, and access to health information.

This information applies to:

• Elderplan for Medicaid Beneficiaries (HMO-POS D-SNP)
• Elderplan Select (HMO-POS I-SNP/IE-SNP)
• Elderplan Advantage for Nursing Home Residents (HMO-POS I-SNP)
• Elderplan Plus Long-Term Care (HMO-POS D-SNP)

Medicaid Rights & Responsibilities

Members who receive Medicaid benefits have additional rights related to access to care, language assistance services, privacy protections, Fair Hearings, External Appeals, and other protections under New York State Medicaid law.

This information applies to:

• Elderplan for Medicaid Beneficiaries (HMO-POS D-SNP)
• Elderplan Plus Long-Term Care (HMO-POS D-SNP)
• HomeFirst Managed Long-Term Care (MLTC)

Long-Term Care Member Rights

Members who receive long-term services and supports (LTSS) have additional rights related to care management, person-centered service planning, service authorization decisions, Fair Hearings, aid-continuing, and other long-term care protections.

This information applies to:

• Elderplan Plus Long-Term Care (HMO-POS D-SNP)
• HomeFirst Managed Long-Term Care (MLTC)

Complaints, Appeals & Independent Help

If you disagree with a decision about your care, services, or coverage, you have the right to request a review and may have access to appeal rights, Fair Hearings, External Appeals, or other review processes.

You can also receive free, independent assistance from organizations that help members understand their rights and navigate Medicare, Medicaid, and long-term care services.

Learn more about:

• Grievances and complaints
• Medicare appeals
• Medicaid appeals
• Fair Hearings
• External Appeals
• Independent Consumer Advocacy Network (ICAN)
• Other advocacy and ombudsman programs

Need Help?

If you have questions about your rights, responsibilities, benefits, or coverage, Member Services can help direct you to the information and resources that apply to your plan.