Making the Most of Medicare Benefits and Rights

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It’s common knowledge that Medicare covers hospital stays and sick visits to a physician. But the federal health insurance program covers much more—from preventive care and wellness visits to medication management. Here are a few benefits and rights that Medicare beneficiaries have.

Welcome to Medicare Visits

Medicare beneficiaries enrolled in Medicare Part B (medical insurance) are entitled to a "Welcome to Medicare" preventive visit within the first 12 months of securing coverage.

This initial visit includes a review of the patient’s medical history, as well as education and information about preventive services including a written plan about screenings, shots and other services. The visit is designed to keep beneficiaries healthy by making them aware of things they can do to take charge of their wellness.

Yearly Wellness Visits

Beneficiaries also have access to yearly "wellness" visits. If a beneficiary has had Medicare Part B for more than 12 months, he or she can have a yearly wellness visit to develop or update a personalized health care plan to help prevent disease and disability. Together, a beneficiary and his or her physician can work on this plan.

The annual wellness visit may also include:

  • Developing or updating a list of current providers and prescriptions (e.g., if another physician has prescribed medications, beneficiaries should share this information with their primary care physician)
  • Personalized health advice
  • A screening schedule—similar to a checklist—for appropriate preventive services and screenings (many of which are covered by Medicare)
  • Advance care planning

Before a wellness visit, beneficiaries are encouraged to write out a list of questions or concerns they want to address with their doctor. If they are unsure of what questions to ask, they can refer to the American Heart Association’s “Doctor Appointments: Questions to ask your Doctor.”

Medicare Rights

Besides visiting primary care physicians, Medicare beneficiaries may be admitted to hospitals or nursing homes, or require home health services at some point in their lives. During these times, beneficiaries should be aware of their Medicare rights, which include the right to file complaints and appeals.

Medicare beneficiaries and their representatives have the right to file an appeal if they disagree with a coverage or payment decision, or if Medicare stops providing or paying for all or part of a service, supply, item or prescription.

Beneficiaries also have the right to file an appeal through their Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO) if they disagree with a provider’s decision to discharge them from the hospital or discontinue skilled services; or they can file a complaint when they have a concern about the quality of the medical care they are receiving from a health care professional or facility.

Examples of quality of care concerns include but are not limited to:

  • Receiving the wrong medication
  • Receiving an overdose of medication
  • Receiving unnecessary surgery
  • Receiving unnecessary diagnostic testing
  • Experiencing a change in condition that was not treated
  • Receiving a misdiagnosis
  • Receiving inadequate discharge instructions

BFCC-QIOs are contractors for Medicare and help Medicare beneficiaries exercise their right to high quality health care. BFCC-QIOs manage all beneficiary complaints and quality of care reviews.

Medicare beneficiaries should stay informed about Medicare rights and benefits by reading information sent to them by Medicare, including the Medicare & You handbook (mailed once a year) and Medicare Summary Notices.

Click here for more information about the BFCC-QIOs and how they help Medicare beneficiaries.