Medicare: Do You Know Your Rights?
Posted on Jun 30, 2011
I was walking down the hallway of a hospital one afternoon when I encountered a woman who would help shape my future. She was sitting in a wheelchair, naked with only a hospital gown loosely draped over her body and she had been left facing a wall in the hallway. She was crying softly, asking politely if someone could take her back to her room. I could sense how uncomfortable and embarrassed she felt being left so exposed in a hallway of a busy hospital, unable to see people coming and going behind her. There were four nurses standing less than ten feet behind this woman, laughing and sipping soda, not paying any attention to this woman.
By now you have probably guessed that the crying woman was elderly, probably in her late 80’s or early 90’s. I stopped by her wheelchair and asked when someone would be taking this woman back to her room. The nurses said that someone would take her to her room, yet none of them made a move to do so. I was just a patient after all, not a physician on staff, not an executive in management at the hospital. All I could think of was how angry I felt about the treatment of this woman. What if she had been my mother, grandmother, or sister? While I would later file a complaint against the facility, nothing would or could undo the embarrassment and discomfort this woman had suffered.
Congress passed The Social Security Act in 1965. This Act established the Medicare program, a health insurance program for people who are 65 years of age or older, or who are disabled. Medicare is funded through a federal payroll tax on working Americans and a monthly premium imposed on Medicare beneficiaries. Since 1965, the federal government has amended this law several times and issued hundreds of thousands of pages of regulations, rules and policy guidelines that are supposed to shed light on the rights of Medicare beneficiaries and the obligations of health care providers. It has been 40 years since the Medicare program was created, yet Medicare beneficiaries are usually unaware of their rights to services and seem even more at a loss on how to assert those rights.
The purpose of this article is to outline some of the basic rights Medicare beneficiaries have, starting with the most basic right of being treated with respect. Federal law specifically prohibits discrimination in treatment by health care providers against Medicare beneficiaries based on age, sex, or religious beliefs.
So what are some examples of discrimination against Medicare beneficiaries? Leaving an unclothed elderly woman in a wheelchair, pushed up against a wall in a hallway is certainly one example. Think about it. How many of us would expect to see the same thing happen to a 45-year-old man? Another example is a health care provider chiding or laughing at a patient for their religious beliefs or practices. Medicare also takes a dim view of providers who do not ensure patient privacy. For example, patients are not to be left partially or fully unclothed on a bed or examination table unless they are protected by a screen or curtain from public view. How many of us have walked down the hallway of a hospital or nursing home and seen an elderly man or woman left partially or fully naked on a bed with the door to her room open? I have seen this happen more times than I care to count.
So what are other basic rights of Medicare beneficiaries?
Medicare beneficiaries also have the right to:
- Make a choice about who their physician will be.
- Have an evaluation in an emergency room if they believe they are ill or injured.
- Information on whether a health care service is covered by Medicare and a written estimate of cost if a service is not covered by Medicare prior to that service being given to the patient.
- A discharge plan being developed before they are discharged from the hospital. What is a discharge plan? A discharge plan is a plan for care that helps the patient transition back to living independently in their home, or it is a plan to move the patient to a rehabilitation or nursing home facility for a short period of time. A discharge plan requires a doctor’s order for home health care services, durable medical supplies (walker, crutches, wheelchair), or an order for rehabilitation care (physical therapy) with an estimated length of stay.
- Appeal a decision by a physician that the patient is ready for discharge from the hospital and to remain in the hospital while the appeal is considered.
- Access mental health services from a psychiatrist, psychologist or other recognized Medicare mental health care provider.
- Question the bill for services rendered.
- Access nursing home services. Be aware, however, of Medicare’s limitations on payment for nursing home services. Medicare covers what are known as skilled nursing beds for limited periods of time, but it does not cover other levels of care that are also provided in nursing homes, like custodial care beds.
Apply for Medicaid benefits if they are lower income and have limited assets. Medicaid can pay the Part B premium ($1,200 approximately per year per beneficiary) for lower income Medicare beneficiaries. Medicaid can also pay for medical supplies and nursing home costs for custodial care for Medicare beneficiaries who qualify under income and asset tests.
The image of the elderly woman in that hospital hallway has stayed with me, causing me to revise my career plan as a lawyer. I do not know her name, or what happened to her after that day, but she is part of the reason that I am now focusing on Estate Planning and Elder Law after nearly 15 years in health care policy and law.
The truth is that we are all going to age and will likely become dependent on others to assure that we are treated with dignity and respect in all aspects of life, especially in medical settings. So, when you think about it, all of us need to be aware of how elders are treated in health care settings and speak up when we see situations that are not in keeping with the standards of care, respect and dignity we would expect for ourselves and our loved ones.