Your rights as a patient
Medicare establishes specific rights at every care setting. Most patients are never told about them unless they ask. Knowing them before a dispute gives you leverage that disappears after you have already left or accepted a decision.
Dollar figures reflect 2025 Medicare rates. CMS adjusts these annually. Verify current rates at medicare.gov before making decisions.
Rights during a hospital stay
These rights apply to every Medicare patient in every hospital, regardless of coverage type.
Rights in a skilled nursing facility
Residents of skilled nursing facilities have a specific set of rights under federal law, separate from hospital rights. These apply whether the stay is short-term Medicare rehabilitation or long-term residence.
Every SNF resident has the right to receive a written care plan that includes goals, the services being provided, and who is responsible for each. You have the right to participate in developing and reviewing the care plan, and to have a family member or representative participate on your behalf.
Care plan meetings are typically held shortly after admission and before any significant change in status. Ask when the next care plan meeting is and request to participate. Ask to receive a copy of the care plan in writing.
When a SNF determines that Medicare coverage will end - because skilled need has ended or you have reached day 100 - they must provide a Notice of Medicare Non-Coverage at least two days before coverage ends. You have the right to appeal this determination to the BFCC-QIO.
File the appeal before the end of the day listed on the notice for maximum protection. While the QIO review is pending, Medicare continues to cover the stay and you cannot be billed.
The QIO review focuses on whether skilled care was still needed. If the therapist's notes document that the patient has plateaued and no longer requires skilled intervention, the QIO is likely to uphold the termination. If the clinical record shows ongoing skilled needs that were prematurely discontinued, the QIO may reverse the determination.
Every SNF must have a grievance process and must respond to formal complaints promptly. If you have a concern about the quality of care, staffing, dignity, or any aspect of the facility, you can file a formal grievance with the facility's administrator.
If the grievance process does not resolve your concern, contact your state's Long-Term Care Ombudsman. The Ombudsman is a government-funded advocate for nursing home and assisted living residents, independent of the facility. The Ombudsman can investigate complaints, advocate on behalf of residents, and refer matters to state licensing agencies when warranted. Ombudsman services are free and confidential. Find yours at ltcombudsman.org or by calling the Eldercare Locator at 1-800-677-1116.
Rights during home health
Medicare home health patients have specific rights under the Home Health Patient Rights rules.
If a home health agency terminates coverage without providing the required Advance Beneficiary Notice in advance, you have grounds to dispute the termination. Contact the agency's supervisor first and request the specific clinical reason coverage is ending and when the ABN was or will be provided.
If the termination appears premature and skilled need still exists, contact your BFCC-QIO. The same appeal process that applies to hospital discharge applies to home health coverage termination. File the appeal before the end of the coverage termination date for maximum protection.
The Medicare appeals process
Medicare has a five-level formal appeals process. Most coverage disputes that cannot be resolved informally go through some or all of these levels.
The BFCC-QIO
The Beneficiary and Family Centered Care Quality Improvement Organization is the entity that handles expedited appeals - the fast-track reviews that happen while you are still in a care setting.
The phone number for your QIO is printed on the Important Message from Medicare notice that the hospital is required to give you. It is also on any Notice of Medicare Non-Coverage you receive.
If you do not have either of those documents, call 1-800-MEDICARE (1-800-633-4227). Tell the representative you want to contact your BFCC-QIO for a fast-track appeal. They will provide the contact information for your region.
You can also find QIO contact information at cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Quality-Improvement-Organizations/List-of-QIOs.
Two organizations currently serve as BFCC-QIOs for different regions of the country: Kepro (serving most states) and HSAG - Health Services Advisory Group (serving several western states). Your appeal documentation will include specific contact information for whichever QIO serves your state.
About the figures on this page. Dollar amounts and program thresholds reflect published 2025 rates from the Centers for Medicare & Medicaid Services (CMS) and the Social Security Administration (SSA). CMS adjusts most figures annually, typically in the fall before each coverage year. Verify current rates at medicare.gov or ssa.gov before making enrollment or coverage decisions. Project Kos is an educational resource. Nothing on this page is legal, financial, or medical advice.