Department of Health and Human Services

Office of Inspector General

Medicare Beneficiary Advisory Bulletin

Complete Text of Report is available in PDF format.

What Medicare Beneficiaries
Need to know About
Health Maintenance Organizations (HMO)
Arrangements:
Know Your Rights

This Advisory Bulletin provides important information about HMO obligations and beneficiary rights:

• regarding enrollment in an HMO;
• the provision of services by HMOs to beneficiaries; and,
• disenrollment from an HMO.

It also provides information about how beneficiaries enrolled in HMOs can seek help, and where they can file complaints if they believe that their rights have been violated or an HMO has acted inappropriately. This Advisory Bulletin should be helpful to Medicare beneficiaries who are thinking about joining an HMO as well as those who are already enrolled.

The Advisory Bulletin provides information on what beneficiaries need to do if they believe their HMO is not meeting its obligations or may be violating their rights. This includes:

• Complain directly to the HMO;
• Contact the local or State Insurance Counselling and Assistance Program. (Toll-free Hot Line numbers listed)
• Contact the HHS Office of Inspector General through its toll-free Hot Line or the HCFA Medicare toll-free Hot Line number