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Your Medicare Rights

Your hospital rights under Medicare

If you are on original Medicare or a Medicare Advantage plan, when you are admitted to the hospital, you should get a notice called “An Important Message from Medicare.” This notice explains your rights while you are in the hospital. If you do not receive this notice, call the Arkansas Foundation for Medical Care (AFMC) at 1-888-354-9100. To view this notice, click here.

If you are on Medicare, you have these rights:

  • To receive the hospital care needed to find out what is wrong with you and treat your illness or injury.
  • To remain in the hospital as long as is medically necessary.
  • To be informed about decisions affecting your Medicare coverage and payment for all services.
  • To appeal any written notices you receive from the hospital.
  • To receive a written discharge plan before you leave the hospital.

Click a heading below, or just keep reading for more information.

If the hospital refuses to admit you because Medicare will not pay:

You have the right to be admitted to the hospital, even if you have to pay. Some services, like certain lab tests, can be provided without a stay in the hospital. Medicare will pay for a hospital stay when medically necessary. If you feel you need care in a hospital, but the hospital says that Medicare will not pay for it, ask for that decision in writing. If you choose to be admitted after getting a written notice of non-coverage, you may have to pay the hospital bills.

If you do not agree with the notice of non-coverage, you can call AFMC to appeal. If you appeal within three days of getting your notice, AFMC will make a decision within two working days. If you wait until after leaving the hospital to appeal, AFMC will make a decision within 30 days. Remember, without a written notice of non-coverage, you have no right to an immediate appeal.

You may appeal a hospital’s denial of Medicare coverage by calling AFMC at 1-888-354-9100.

If you are told Medicare will no longer cover your stay in the hospital:

You should receive another copy of the "Important Message from Medicare." It will instruct you to call AFMC to request an immediate review of your case, and we are available seven days per week to conduct this review. If you call before midnight of the planned day of discharge, the hospital cannot discharge you until you receive a review decision from AFMC. Once you request an appeal, AFMC has 24 hours from receipt of your medical record to make a decision about your continued care. To view this notice, click here.

Medicare Rights in Other Settings

On July 1, 2005, other types of health care providers began issuing a notice of non-coverage before they stop care, whether or not the patient disagrees.

You should get this notice if you're getting care from any of the following, and that care is going to stop:

  • Hospice
  • Home health agency
  • Skilled nursing facility or hospital "swingbed" (for people who are not sick enough for the hospital, but still need full-time nursing care)
  • Comprehensive outpatient rehab facility (a clinic for patients who no longer need full-time care but still need special treatment)

To find out more about requesting an immediate appeal, click here

Notice of Medicare Provider Non-Coverage 

If you belong to a Medicare Advantage health plan...

...and you disagree with a notice to stop your services from a health care provider or facility: You have a right to request a "fast-track" appeal. If you disagree with your Medicare Advantage health plan's decision to end services received from:

  • a skilled nursing facility
  • a comprehensive outpatient rehab facility
  • a home health agency

then you can request an appeal from AFMC. To find out more about requesting a fast track appeal, click here.

Other services covered by Medicare:

Medicare provides a variety of preventive services for men and women with Medicare. It covers a yearly screening mammogram for women age 40 and older on Medicare. Medicare also pays for a screening pelvic exam and pap smear for women once every two years. For men, Medicare pays for a yearly PSA blood test for the early detection of prostate cancer.

Medicare also pays for a yearly flu shot and a lifetime pneumococcal pneumonia shot for all beneficiaries, regardless of age. For more information on these and other preventive services, go to www.medicare.gov and access the Publications section.

Other helpful numbers:

  • Medicare Services: 1-800-MEDICARE
  • Social Security Administration: 1-800-772-1213
  • Arkansas Insurance Department: 1-800-224-6330
  • Arkansas Department of Human Services:
    1-800-482-5431 or 1-800-482-1141
  • Attorney General's Office, Consumer Protection Division:
    1-800-482-8982
  • Durable Medical Equipment: 1-800-MEDICARE