Medicare Rights & Responsibilities

Members enrolled in an Elderplan Medicare Advantage plan have important rights and protections under Medicare.

These rights apply to members enrolled in:

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)

Your Right to Information You Can Understand

You have the right to receive information about your plan, your providers, and your covered services in a clear, easy-to-understand way.

You may request information in your preferred language and in accessible formats, including:

Large print
Audio
Braille
Other alternate formats

at no cost to you.

Your Right to Access Your Health Information

You have the right to access your claims history, clinical information, and other health records.

You also have the right to share your health information electronically with applications and services you choose.

Your Right to Nondiscrimination

You have the right to receive services without discrimination based on race, color, national origin, age, disability, sex, or other protected characteristics.

Your Right to Emergency Care

You have the right to receive emergency care without prior authorization.

If you believe your health is in danger:

Call 911
Go to the nearest emergency room

Emergency care is covered whether the provider is in-network or out-of-network.

Your Right to Know About All Treatment Options

Your providers have the right and responsibility to discuss all medically appropriate treatment options with you, even if your plan does not cover a particular treatment.

Your Right to Participate in Decisions About Your Care

You have the right to:

Participate in decisions about your health care
Accept treatment
Refuse treatment

Refusing treatment will not affect your access to other covered services.

Your Right to Out-of-Network Coverage When Necessary

If a Medicare-covered service is not available from a network provider, you have the right to receive the covered service from an out-of-network provider at no greater cost than if the service had been obtained in-network.

Your Right to an Advance Directive

You have the right to make decisions about your future medical care through documents such as:

Health Care Proxy
Living Will
MOLST
Do Not Resuscitate (DNR) Order

Your wishes will be honored in accordance with applicable laws.

Your Right to Privacy

You have the right to have your personal health information protected and handled confidentially.

You may request access to your records and request corrections when appropriate.

Your Right to File Complaints and Appeals

You have the right to:

File a grievance (complaint)
Request a coverage decision
Appeal a denial or coverage decision
Appoint someone to act on your behalf

Medical Coverage Decisions & Appeals →

Drug Coverage Determinations & Appeals →

Your Right to Disenrollment Information

You have the right to information about your options if you choose to leave your plan or enroll in another Medicare plan.

Your Responsibilities as a Member

As a member, you are responsible for:

Presenting your Member ID card when receiving services
Following plan rules when applicable
Working with your providers to obtain required approvals
Providing accurate information to your providers
Treating providers and plan staff with respect
Reporting suspected fraud, waste, or abuse