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My Aspire Health Plan Rights

What are my Medicare rights with an Aspire Health Plan?

If you have Medicare, you are guaranteed certain rights and protections. More detailed information is available in your plan documents (i.e., Evidence of Coverage), or in the Medicare & You (en español) handbook or Medicare Rights and Protections document available on the Medicare website. You can also call Medicare toll-free, 24 hours a day, 7 days a week at 1-800-MEDICARE (1-800-633-4227) (toll-free) or 1-877-486-2048 (toll-free TTY for the hearing/speech impaired).

As a member of the Aspire Health Plan, you are entitled to:

  • Be treated with dignity and respect at all times.
  • Be protected from discrimination.
  • Have your personal and health information kept private.
  • Get information in a way you understand from Medicare, healthcare providers, and under certain circumstances, contractors.
  • Get clear and simple information about Medicare to help you make healthcare decisions.
  • Have your questions about Medicare answered.
  • Have access to doctors, specialists, and hospitals.
  • Learn about your treatment choices in clear language that you can understand, and participate in treatment decisions.
  • Get healthcare services in a language you understand and in a culturally sensitive way.
  • Get emergency care when you need it.
  • Get a decision about healthcare payment, coverage of services, or prescription drug coverage.
  • Request a review (appeal) of certain decisions about healthcare payment, coverage of services, or prescription drug coverage.
  • File complaints (sometimes called “grievances”), including complaints about the quality of your care.
  • Choose healthcare providers within the plan so you can get the healthcare you need.
  • Get a treatment plan from your doctor.
  • Know how your doctors are paid.
  • Request an appeal to resolve differences with your plan.
  • File a complaint/grievance about other concerns or problems with your plan.
  • Get a coverage decision or coverage information from your plan before getting services.

Rights and Responsibilities Upon Disenrollment

Since the Aspire Health Plan (HMO and HMO-POS) plans are Medicare Advantage plans with Part D prescription coverage, that means your prescription coverage will end if you disenroll in our plan. If you disenroll with us, you should consider signing up for a new Medicare Advantage plan or Medicare Prescription Drug plan to ensure that you are covered for prescription drugs. Your options include:

  • Enrolling in a different Medicare Advantage plan with prescription drug coverage
  • Using Original Medicare for your medical needs, plus enrolling in a Medicare Prescription Drug plan
  • If you do not choose one of these options, or obtain creditable prescription drug coverage elsewhere, you may have to face a late enrollment penalty if you decide to get Medicare prescription drug coverage at a later date.