Your rights in Medicare drug plans

You the same rights and protections as all people with Medicare. In addition, if you have a Medicare drug plan, you have the right to:

  • Get a written explanation for drug coverage decisions (called a “coverage
    determination”) from your Medicare drug plan. A coverage determination
    is the first decision your Medicare drug plan (not the pharmacy) makes
    about your benefits. This can be a decision about if your drug is covered, if
    you met the plan’s requirements to cover the drug, or how much you pay
    for the drug. You’ll also get a coverage determination decision if you ask
    your plan to make an exception to its rules to cover your drug.
  • File a complaint (called a "grievance") with the plan.
  • Have the privacy of your health and prescription drug information protected.

If you have Medicare prescription drug coverage, your plan will send you information that explains your rights. Call your plan if you have questions.

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